ETHTE 12-5-29492
II CTT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 C LILT HARNETT BOULEVARD
LII. LINGT N, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
Name: Jahn Gordon Phan 286-2705
Address: 1976 Cameron Hill Cameron NC 28326
Name of Mobile Home ark or S :
Name of Owner (if different):
BUILDING MUST BE 5FROM ANY PART OF SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION P EXISTING SYSTEM
Signature ofEnvironmental