ETHTE#.
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME PHONE # 94 9 —Y
ADDRESS a
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT) 1 �S
ADDRESS OF OWNER (IFDIFFERENT) V,
PROPERTY LOCATION: STATE ROAD NAME AND #
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
BUILDINGAUST
00NOT''DRIVE OR PARK ON SEPTIC SYSTE
AUTHORIZATION OF EXISTING SYSTEM
F Ia
of Environmental