ENVH RefundHarnett
COUNTY
NORTH CAROLINA
Account Number:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Date: June 20, 2016
COUNTY OF HARNETT
CHECK REQUEST FORM
110-0000-345.18-00
Gary Gerlach
551 Hillbrook Road
Cameron, NC 28326
Mail to payee
Check to be picked up by:
(Requires approval of Finance Officer)
Approved:_ Disapproved:_
Reason for check request: Proposed 30 x 40 detached garage placement. Tank inspection waived due to the
distance from septic and drainfield area per Graham Byrd.
This check request has been examined by me and is hereby approved for payment.
Department Head o5Authorized Designee Date
Graham H. Byrd, R.E.H.S. y'
T61 rument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
Description
Amount
ENVH Existing Tank Fee
$ 100.00
For Gary Gerlach
Location: 51 Hillbrook Drive
Bridlewood Hills Lot 11
HTE # 16-5-38904
Total Amount Due
$ 100.00
Reason for check request: Proposed 30 x 40 detached garage placement. Tank inspection waived due to the
distance from septic and drainfield area per Graham Byrd.
This check request has been examined by me and is hereby approved for payment.
Department Head o5Authorized Designee Date
Graham H. Byrd, R.E.H.S. y'
T61 rument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director