ETHTE# 4 -S- 397
HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME 714-uf
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFERENI)
ADDRESS OF OWNER (IF DIFFERENT)
PHONE # 7/ 9-6 OZ - 8�i
C
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
BUILDING MUST BE 5' FROM ANY PART OF SEPTIC SYSTEM
DO' NOT DRIVE OR PARK ON SEPTIC SYSTEM,...,
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health
71-7- ( 6
Date