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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME ~ A ~ I-,- U4, L,, -16,u 7 PHONE #
ADDRESS
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
Gu.,
H, I,
( SC, Y
ADDRESS OF OWNER (IFDIFFERENI)
PROPERTY LOCATION: STATE ROAD NAME AND # ! " e j ~
The aforementioned site has been evaluated by the Hamet' I County Health Department
Environmental Health Section, At the time of inspe*i there appeared to bo i septic
system servlh'tale site; If this system 'shourd malftincdonj thi owner le responalbfe for
any,, newssao repairs. t
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 5! FROM ANY PARS' OF SEPTIC SYSTEN
00 NOT DRIVE OR PARK OIL SEPTIC SYSTEW _
AUTHORIZATION OF EXISTING SYSTEM
Signature of Environmental Hea)6 Specialist
'05
Date