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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME y 14eL
ADDRESS Z
PHONE # 7 I
W
NAME OF MOBILE HOME PARK OR S/D 2
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT) f __
PROPERTY LOCATION: STATE ROAD NAME AND # 5Z 14
ZP s
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
•
of Environmental Health Specialist
:bwj
Date