ETHTE 12-5-29383
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Jerry Massey Phone 574-5293
Address: PO Box 371 Bunnlevel NC 28323
Name of Mobile Home Park or S/D:
Name of Owner (if different):
BUILDING UST 5'FROM ANY PART SEPTIC SYSTEM
NOT DRIVE OR PARK N SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signature