ENVH RefundHarnett COUNTY OF HARNETT
CHECK REQUEST FORM
NORTH CAROLINA
Account Number: 110-0000-345.18-00 Fx]Mail to payee
Project Number: F I Check to be picked up by:
Vendor Name: Gerald Tripp
Vendor Number: (Requires approval of Finance Officer)
Remittance Address: P O Box 309 Approved: Disapproved:
Date 7-22-11 Angier, NC 27501
919-369-6439
Description
Amount
Environmental Health Soil Evaluation Fee
$ 250.00
Land Use Application # 11-5-27151
Site: Lot 11 Barclay's Subdivision
Total Amount Due
$ 250.00
Reason for check request:
Applicant changed his mind regarding soil evaluation to sell home as a 3 bedroom
versus the two bedroom it was originally permitted for, and requested a refund.
Since no site visit has been made Environmental Health will issue a refund of the
above fee.
This check request has been examined by me and is hereby approved for payment.
Department He r A or'z Des'e f Date
Graham H. Byrd, R.E.H., i
This instrument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Harnett County Finance Director