ETHTE# I Lj - S 1
ADDRESS 5'1 °aj
NAME OF MOBILE HOME PARK OR S/D
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
i' ' ! ! PTIC SYSTEM
1 ! 1 ! ! ` SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date