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TO: CABARRUS COUNTY DEPARTMENT OF SOCIAL SERVICES <br /> (FAX NO. 788- 8420) <br /> <br /> I am requesting a financing program for the water and/or sewer <br />connection fee from the Cabarrus County Water & Sewer Department. <br />In order to determine that I qualify for such program , the <br />Department of Social Services must verify my financial situation. <br /> <br /> I hereby give permission to the Cabarrus County Department of <br />Social Services for the release of information concerning my <br />household's financial situation to the Cabarrus County Water & <br />Sewer Department. <br /> <br /> This release is valid for a period of~90 days from the date <br />signed. <br /> <br />SIGNATURE <br /> <br />DATE <br /> <br />TO: Cabarrus County Water & Sewer Dept. (Fax No. 788-8194) <br /> This person is receiving financial assistance from our agency <br /> and would benefit from the financing program offered by the <br /> Cabarrus County Water and Sewer District for a water and/or <br /> sewer connection fee. <br /> <br />SIGNATURE OF DSS EMPLOYEE <br />TITLE: <br /> <br />DATE: <br /> <br /> <br />