ETHTE #: 13 -5 -30862
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
1
Name: Jose Hervera Saldivar Phone #: 919- 777 -2924
Address: P.O. Box 4732 Sanford NC 27331
Name of Mobile Home Park or S /D: John M
Name of Owner (if different): Clyde Patterson
Address of Owner (if different): 4271 Leaflet Church Rd. Broadway, NC 27505
Property Location (State Road name and #): McKoy Town
Purpose of Inspection: replace home
The aforementioned site has been evaluated by the Harnett County Health Department
Environmental Health Section. At the time of inspection, there appeared to be a septic
system serving this site. If the system should malfunction, the owner is responsible for any
necessary repairs.
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 change, and /or
4. after six months
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AUTHORIZATION OF EXISTING SYSTEM
ignature of Environmental Health Specialist
WWAM
Date