ETHARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAMEr PHONE
ADDRESSE, ca• V )
NAME OF MOBILE HOME PARK OR S/D —I-H-e� C4eePC &.+l
NAME OF OWNER (IFDIFFEREN7)
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ADDRESS., f "
ruck -I
PROPERTY
t .,:: i ,... .O, STATE ROAD
aME A ,
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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' - - -SEPTIC SYSTE
T OF SEPTIt SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
u ,nSpecialist