ET RHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME �° -�� PHONE #_/
ADDRESS '
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ,
Dy Fn Met—
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
'MUST BES, BU WING-
OM AN 'PART OF SEOTIC'SYSTEM.
DQ'N`0T DRIVE OR PARK ON: M
SEPTIC SYSTE
AUTHORIZATION OF EXISTING SYSTEM
of Environmen tal Health Specialist Date