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HARNETT COUNTY HEALTH DEPARTMENT
ENVJRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME <, ���Jli� PHONE # JZ
ADDRESS 55Z( 0!D i3uc� 5 �iL2P,i/ fG� CrQ A)
NAME OF MOBILE HOME PARK ORS/DJ
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7) ,A? J 6 AJ • C— 073-0/
PROPERTY LOCATION: STATE ROAD NAME AND #
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 sin months
BUILQII
AUTHORIZATION QF EXISTING SYSTEM
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