ETI HTE# 1 p3 0b_3
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
PHONE #
ADDRESS 7
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # r
PURPOSE OF dtA—
INSPECTION;,
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
nolb, 6 tot
BUILDIN,aMUST BE FFROM ANTPART'OF SEPTIC'SYSTEM:
-OT DRIVE OR PARK ON SEPTIC SYSTEW''. .
AUTHORIZATION OF EXISTING SYSTEM
iieaun specialist