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HARNETT COUNTY HEALTH DEPARTMENT
ENVXRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME / l��� I
ADDRESS ZSIy _r*"U 0
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IF DIFFERENT)
ADDRESS OF OWNER (IF DIFFERENT)
PHONE # ZQ(t- Z�l -- 9ZIS
� A)C-zr' N.C.07r6l
PROPERTY LOCATION: STATE ROAD NAME AND # -2t A///4aA
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
onvironm
f Eental Health Specialist Date