ENVH REFUNDAccount Number:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address
Date 8-05-11
110-0000-345.18-00
James Hartman
245 Briar Creek Lane
Coats, NC 27521
❑ Mail to payee
F-I Check to be picked up by:
(Requires approval of Finance Officer)
Approved: Disapproved:
Description
Amount
Environmental Health Well Construction Fee
$ 250.00
Application # 11-5-27253
Site: 245 Briar Creek lane
Total Amount Due
$ 250.00
Reason for check request: Town of Coats will not allow applicant to have a well for consumption purposes because
he already has public water supply. No permit needed for an irrigation well.
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
Graham H. Byrd, R.E.H.S._
This Hfstrument has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Date
Harnett County Finance Director