ENVH RefundHarnett
C 0 U N T Y
NORTH CAROLINA
Account Number
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Date 1-14-16
COUNTY OF HARNETT
CHECK REQUEST FORM
110-0000-345.18-00
Cumberland Homes
P 0 Box 727
Dunn, NC 28335
❑X Mail to payee
Check to be picked up by:
(Requires approval of Finance Officer)
Approved:_ Disapproved:
Reason for check request: Fee paid for and taken in error by Central Permitting. This site is supplied by county sewer.
This check request has been examined by me and is hereby approved for payment.
Department Head 2ruthorized Designee Date
Graham H. Byrd, R.E.H.S.
Thi trun ent has been
preoudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
Description
Amount
ENVH Soil Evaluation Fee
$ 750.00
Location: Lt. 42 The Gate @ Lexington S/D
NC Hwy 87
HTE # 15-5-37741
PIN # 9594-59-4037.00
Total Amount Due
Landowner & Applicant: Cumberland Homes
$ 750.00
Reason for check request: Fee paid for and taken in error by Central Permitting. This site is supplied by county sewer.
This check request has been examined by me and is hereby approved for payment.
Department Head 2ruthorized Designee Date
Graham H. Byrd, R.E.H.S.
Thi trun ent has been
preoudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director