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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS"TING SEPTIC SYSTEM INSPECTION
NAME �/PSSe /1i/O"dic�Q/—// PHONE#
ADDRESS �// 5 ��%�[d�P'P /)yW-'4j /f,1� X'(/ /J , C • ZZ
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND # l yD S LI)7/.i/(Lt.
voatit
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
of
AUTHORIZATION OF EXISTING SYSTEM
Specialist
Date