ENVH RefundHarnett
fOUNTY
COUNTY OF HARNETT
CHECK REQUEST FORM
A nn --.R C) N
Account Number:
110-0000-345.18-00
Steve Thomas
P O Box 875
Broadway, NC 27505
5~ Mail to payee
FICheck to be picked up by:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
(Requires approval of Finance Officer)
Approved: Disapproved:
Description
Amount
Difference between cost for a soil evaluation and
$ 150.00
an existing tank inspection. Applicant paid
250.00 and the fee for an existing tank is $100.0
Application # 10-5-25255
Amount of refund owed = $150.00
Total Amount Due
$ 150.00
Reason for check request: Applicant decided to use existing drainfield and to set a new tank, no soil evaluation
necessary.
This check request has been examined by me and is hereby approved for payment.
Department Head or Authorized Designee Date
This insturment has been
preoudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director