ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL 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 (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #
F -r-/(=, bjxri4
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
D -MUST BE 5" FROM AN 'PART OF SEPTIC'SYSTEM:
BUILING Y
DOW DRIVE OR PARK ON SEPTIC SYSTEM.
AUTHORIZATION OF EXISTING SYSTEM
6- 7
S* re of Environmental Health Specialist Date