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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME o V S% PHONE # �q/O 7 S
ADDRESS s 7-2 7e�'O- t 6-C Gp
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFIERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # t'7 0'3
PURPOSE OFINSPECT'ION.�o?�u
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system s�nnnc t ii se e, t t�i� fuod dir. Ihe�owner is resp�on�ib a foc
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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
AUTHORIZATION OF EXISTING SYSTEM