ENVH RefundCOUNTY OF HARNETT
CHECK REQUEST FORM
NORTH CAROLINA
Account Number:
110-0000-345.18-00
Project Number:
Vendor Name:
Adam Swann
Vendor Number:
Remittance Address:
216 Buie Road
Date
Broadway, NC 27505
❑X Mail to payee
Check to be picked up by:
(Requires approval of Finance Officer)
Approved: Disapproved:
Description
Amount
Refunding difference between the fee for a soil
$ 650.00
evaluation ($750.00) and existing tank inspection
fee ($100.00)
Application # 11-5-27721
Total Amount Due
$ 650.00
Reason for check request: Applicant paid the fee for a soil evaluation but later discovered there was a septic tank
on the property. Since no soil evaluation was completed, Environmental Health will
refund the difference between the two.
This check request has been examined by me and is hereby approved for payment.
Department Head or A honzed Designee Date
Graham H. Byrd, R.E.H.S. 1~^
This ins ent has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director
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