ETHTE# 1® 57- 344 13
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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME C J4 PHONE # 9Vo-
ADDRESS 2`)(-r3
NAME OF MOBILE HOME PARK OR S/D N �s
NAME OF OWNER (IFDIFFEREN?)
ADDRESS OF OWNER (IFDIFFEREN7) 1617
,C a
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
BU-ILI)ING'MUST,FROM -
OF SEPT[ SYSTEM,
AUTHORIZATION OF EXISTING SYSTEM
0
re or Environmental Health Specialist