ETHTE 12-5-28505
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Roy Wagner Phone 891-8114
Address: Box 494 Mamers NC 27552
Name of Mobile Home Park or S/D:
Name of Owner (if different):
BUILDING UST E' FROM A PART ®F 'S C SYSTEM
T DRIVE OR PARK N SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
5 13 ~
Signature of Environmental lth Specialist