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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXISTING SEPTIC SYSTEM INSPECTION
NAME_
J PHONE #
ADDRESS I ~ fill l'~~~ ~ 1 ~A/T~P.co
11
NAME OF MOBILE HOME PARK OR S/D
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IFDIFFEREN7)
PROPERTY LOCATION: STATE ROAD NAME AND # kC a -7
The aforementioned site has been evaluated bX the Harnett County Health Department ;
Envlronmenta Health Secdon. At the time of lnspftdoN there appeared to be a septic
system serving thla site, N this system should ma nctlork the owner is responsible fort
any necessary repairs.
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fall or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
BUILDING MUS 13E T FROM ANY PART OF SEPTIC SYSTEM!
00 NOTDRIVE OR PARK ON SEPTIC SYSTEM
AUTHORIZATION OF EXISTING SYSTEM
Signatur of E
Date
Health Specialist