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NAME C k N- t() M N- ~ N ,r-\
PHONE #
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ADDRESS D., n~ • < 1,
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NAME OF MOBILE HOME PARK OR SID
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # M ' C L,! r4 11 v
The aforementioned sits has been evaluated by the Harnett County,Health Department
EmrlronmenW Health Section, At the time of Inspection, theirs appeared to bo a Iss*.1
system servltigtbis site. If thl system'sttouldmalflanctioM thO ownef is responsible for
any necessary repairs, x
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 PART OF SEPTIC SYSTEM
DES NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
iJ~ >r1
of
Health Specialist
Date