ETHARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
PHONE # 916 ' :A;O
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # 15fi
72 UiA&, zdLz
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or )14 4*16 move-,
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
BUI.LDIN,G"MUST. BE 5" FROM ANY PART OF SEIPTIC'SYSTEM;
DQ',NOT DRIVE OR PARKON SEPTIC, SYSTEM.'.
AUTHORIZATION OF EXISTING SYSTEM*
of Environmental Health Specialist