ENVH (Partial) RefundHarnett
COUNTY
NORTH CAROLINA
COUNTY OF HARNETT
CHECK REQUEST FORM
Account Number: 110-0000-345.18-00
Project Number
Vendor Name:
Robert C. Sterling
Vendor Number:
Remittance Address:
2721 Hillmon Grove Road
Date: 12-22-15
Cameron, NC 28326
FX Mail to payee
7 Check to be picked up by:
(Requires approval of finance Officer)
Approved:_ Disapproved:_
Reason for check request: Customer changed their mind and decided to use the septic tank that was already
on the property for the proposed 28 x 72, 4 bedroom, triple wide mobile home.
This check request has been examined by me and is hereby approved for payment.
Department Head or Authoryed Designee _ Date
Graham H. Byrd, R.
This inStfument has been
preaudited in the manner required
by the Locai Government Budget
and Fiscal Control Act
Harnett County Finance Director
Description
Amount
Partial Soil Evaluation Fee (Less $100.00 existing rank)
$ 650.00
Applicant: Robert C. Sterling
Landowner: Ted Brown
300 Still Pond Ln.
HTE # 15-5-37542 R
Total Amount Due
I $ 650.00
Reason for check request: Customer changed their mind and decided to use the septic tank that was already
on the property for the proposed 28 x 72, 4 bedroom, triple wide mobile home.
This check request has been examined by me and is hereby approved for payment.
Department Head or Authoryed Designee _ Date
Graham H. Byrd, R.
This inStfument has been
preaudited in the manner required
by the Locai Government Budget
and Fiscal Control Act
Harnett County Finance Director