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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME /n 6%12Ay PHONE # 9`7 4 - 97,Y- ! 2
NAME OF MOBILE HOME PARK OR S/D ��� i� 6LO- (� �
NAME OF OWNER (IFDIFFERENT)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND #J. JY/ 6� 41)0Pd i.B* 14
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
BUILDINO MUST- 8E5&, MOO ANY PAOOF, SEPTI
DO;IVOT gRIVE 0R PARK ON SEPTIC Sl(S7
AUTHORIZATIO//N�� OA�F.. EXISTING SYSTEM
AYSTEN-::
of Environmental Health Specialist Date