Refund ENVH Well FeeHarnett
LOUNTY
NORTH CAROLINA
Account Number:
Project Number:
Vendor Name:
Vendor Number:
Remittance Address:
Date 8-26-11
COUNTY OF HARNETT
CHECK REQUEST FORM
110-0000-345.18-00 F]Mail to payee
F]Check to be picked up by:
Rudy & Sandra Dennis
(Requires approval of Finance Officer)
56 Ivor Lane Approved: Disapproved:
Erwin, NC 28339
Description
Amount
Environmental Health Well Construction Fee
$ 250.00
Application # 11-5-27370
Site address: 96 Ivor Lane
Total Amount Due
$ 250.00
Reason for check request:
Applicant decided that they were going to connect to an existing well on property.
Since no permit been issued, Environmental Health will refund 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.J
H mrnent has been
preaudited in the manner required
by the Local Government Budget
and Fiscal Control Act
Date
Harnett County Finance Director