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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME Zu,
PHONE # Sio --85?-Slot
ADDRESS 6 qU -L-833Y
NAME OF MOBILE HOME PARK OR S/D
S J
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # c~ 4
The aforemenfioned site has been evaluated by the Harnett County Health Department
Environmental, Health SeWon At the time of inspepttoni them appeared to be a septlC:.d
system serving this site. If this system should, malfuncctloom the owner Is responsible io
zany Wessar epalr - #
k
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
BUILDING MUST BE W FROM ANY PART Q' F SEPTIC SYSTEM
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Si ature of Environments ealth Specialist Date