ETHTE#.
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
347 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 013 �' PHONE # �7®0- Z07 - C 23
ADDRESS 7.7 5aO
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # ;�e®16 d
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
BUILDI
NG MUST. BE 5' FROM ANYPART OF SEPTIC'SYSTEM
OT DRIVE OR PARK ON SEPTIC SYSTE
AUTHORIZATION OF EXISTING SYSTEM
® 7 S®
Sign�tureof Environmental Health Specialist Date