Lodging Est Refund x-ref 09-5-23083Harnett
C O U N T Y Department of Environmental Health
NORTH CAROLINA
REFUND
www.harnett.org
Harnett County Government Complex
307 W. Cornelius Harnett Boulevard
December 18, 2009
Re: Harnett County Application for Lodging Establishments
HTE: 09-5-23083
For: Inn at Barclay Villa at 130 Pope Lake Road
The fee collected at Central Permitting's office was paid in error. There is no plan
review fee for a bed and breakfast. Environmental Health owes a refund of $200.00.
PAYMENT SHOULD BE DIRECTED TO:
Dess Langdon
130 Pope Lake Road
Angier, NC 27501
AMOUNT TO BE REFUNDED $200.00
ZZH. Byrd, R.E.H. Supervisor
ENVIRONMENTAL HEALTH SECTION
GHB/sgs
Lillington, NC 27546
ph: 910-893-7547
fax: 910-893-9371
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HARNETT COUNTY APPLICATION FOR LODGING
ESTABLISHMENTS
(Includes Hotels, Motels, Bed and Breakfast Homes and Inns)
* This application will be reviewed using 15A NCAC 18A .2200 "Rules Governing the Sanitation of Bed and
Breakfast Homes"; 15A NCAC 18A .3000 "Rules Governing the Sanitation of Bed and Breakfast Inns"; or 15A
NCAC 18A.1800 "Rules Governing the Sanitation of Lodging Establishments", whichever is applicable.
Owner:Name:
Address: 130 P600- (QJQ0 Ed -
Phone: fS Fax:
Email: L 1& 4 v , C'c
Applicant: Name: _ -34hPlG AS
Address:
Phone: (ALA - 7 $7o Fax:
Email:
Property Address: 130 824DO-- ca k P &=C)~! k- A1 C
Number of rooms: S"
*Will there be a swimming pool installed?. 111 reWl t j 1 Al SM) 1,04
*Willa continental breakfast be offered'? *S
Please list foods to be served: l nd 1UAuA11 ~j n :1n ~ntt,o~ rmn t9 S i,J hn1e !ru t )
_P 1
ater supply: iA X011 Wastewater type: A 1,~ CC, ~t r~ 1L
Number of ice machines: --(Submit specification sheets on the ice machines) H 1 R&O 7'14 R IL F00 1D
Type of sanitizer/disinfectant used in rooms/bathrooms: S-"IC
We tod l be. LtShX, a lel -nd -Llj <2r vi c e
Type of sanitizer/disinfectant used for laundry: 1
Describe procedures: 1'
Are test strips available to test sanitizer/disinfectant? I
Size of water heater; 0 (1) 100 6A Lt.,ot.)
Te r ure of hot water in rooms: 110 OF
Applicant S gnature Date
*A separate plan review application is required for pools and food establishments. Plan review and approval is
required before construction. Applications and information may be obtained at the Harnett County Health
Department, Environmental Health Section or by calling 910-893-7547.
All items are to be submitted through the Central Permitting Office at 108 East Front St.,
Lillington, NC 27546 or by mail at PO Box 65, Lillington, NC 27546. You may contact the
Central Permitting Office at 910-893-7525, Ext. 2. However, please contact our office with
questions regarding the contents of this application.
X37£
Application nurnher 3 SC'Ji=3
Address -0F'E l~F PAD
Position to
Amount
In A Description
.00;CP MISCELLANEOUS
.1111 CREDiTMEBIT PROC. FEE
25.00 ENVIRON HLTH REVISION FEE
i 250.00 EV< WELL FEE
25.00 EVXRETURN TRIP FOR SEPTIC
00 EXIST. TANK TEST/INSP.
10.110 HOMEOWNER RECOVERY FUND
UU,HS• FOOD AND LODGING
15.001LAt1D USF RENEWAL
OK Exit I Cancel
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