ETHTE 12-5-29405
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Phyllis Clark Phone 919-499-7335
Address: PO Box 541 Mamers NC 27546
Name of Mobile Home Park or S/D:
Name of Owner (if different):
BUILDING UST E 5' FROM ANY T SEPTIC SYSTEM
N DRIVE OR PARK N SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
%,is
Signature of vironmental Health Specialist