ENVH RefundHarnett
C O U N T Y
NORTH CAROLINA
COUNTY OF HARNETT
CHECK REQUEST FORM
Account Number: 110-0000-345.18-00
Project Number
Vendor Name:
Robert Smith
Vendor Number:
Remittance Address:
835 Highgrove Drive
Date 1-14-16
Spring Lake, NC 28390
❑X Mail to payee
7 Check to be picked up by:
(Requires approval of Finance Officer)
Approved:_ Disapproved:
Reason for check request: Applicant wants refund because he is backing out of his purchase of the home to be
placed on the property which is the location of the existing septic tank to be
This check request has been examined by me and is hereby approved for payment.
Department Head orrAuthorized Designee Date
Graham H. Byrd, R.E.H.S. Z z neZ;� L Il
y
./ This instru h been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
Description
Amount
ENVH Existing Tank Inspection Fee
$ 100.00
Location: Buchanan Rd Lt. 2
PIN# 0508-70-3520.000
HTE# 16-5-37780
Robert Smith-Landowner/Applicant
Total Amount Due
$ 100.00
Reason for check request: Applicant wants refund because he is backing out of his purchase of the home to be
placed on the property which is the location of the existing septic tank to be
This check request has been examined by me and is hereby approved for payment.
Department Head orrAuthorized Designee Date
Graham H. Byrd, R.E.H.S. Z z neZ;� L Il
y
./ This instru h been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director