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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME�5%.S
PHONE #i/4-'tee-9o55—
ADDRESS
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NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7) l�iG�l C52
ADDRESS OF OWNER (IFDIFFERENT) Z-75ZG
PROPERTY LOCATION: STATE ROAD NAME AND # a+t i4Y �-T7Gv ✓
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
DO NOT DRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
S� pature of Environmental Health Specialist Date