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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME e PHONE # 915-ila',T/' 7'119
ADDRESS / z f3 y D ma...9- L.,,3 CZ-9-5 rV . z?sL
NAME OF MOBILE HOME PARK OR S/D ,ENNTs S/?> 06
NAME OF OWNER (IFDIFFEREN7) r3o b►-~-L, ,'k r ~,,,-c~P
ADDRESS OF OWNER (IFDIFFEREN7) 3fo re, J,,e 2A C - N. C, 2-7'5Z/
PROPERTY LOCATION: STATE ROAD NAME AND # 52.1-Q0 e-,. +-o
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
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AUTHORIZATION OF EXISTING SYSTEM
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S tore of Environmental Health Specialist Date