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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PHONE # Q/() –9555– SS`Jt,'
=C.
i'lS'SC�
PROPERTY LOCATION: STATE ROAD NAME AND # 5-.V4 /57 K U c.& L i4t�
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 T FROM ANY PART OF SEPTIC SYSTEM:
D NOT DRIVE OR PARK ON SEPTIC SYSTEM- ;
AUTHORIZATION OF
of Environmental Health Specialist
NG SYSTEM
3 23'
Date