ETHTE#
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME?zAM1ALa1_sPHONE#
ADDRESS
7 011
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
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
-MUST BE BUILDING
.;
M AN
_Y PARTbIF SEPTIt SYSTEM:
1i NOT DRIVE OR PARK ON •'
IC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental
Specialist
IM