ETHTE# > 7 _ m
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
NAME / e PHONE # '915 - 4 35 - f 7
ADDRESS-3-781 B ,a�: 2:7T201
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER
ADDRESS OF OWNER
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
ature of Environmental Health Specialist
Date