SW3170804_Change of Permittee Information_20240201

UEMLK USt ONLY
Date Received Fee Paid Permit Number
STATE STORMWATER:
PERMIT INFORMATION UPDATE APPLICATION FORM
There is NO FEE for updating project name or permittee information.
This form is to only to be used by the current permittee to notify the Division of:
1) changes to the Point of Contact(signing official) for the current permittee (LLC, Corporation, HOA or POA);
2) changes to the mailing address, phone number or email address of the current permittee;
3) changes to the name of the project;and
4) changes to the legal corporate name as documented by a Name Change or Merger filed with the NCSOS.
A. NEW PERMIT INFORMATION
State Stormwater Permit Number: SW3170804
Are you updating
(check all that apply): If so, please provide the updated information:
❑ Project name
El Corporation Name'
® Permit Contact Name2.3 William DeForest
® Permit Contact Title Land Development Manager
❑ Mailing Address3
® Phone number 704-267-2271
® Email address William.deforest(cr)lennar.com
Provide documentation such as a Name Change/Merger filed with the NCSOS.
2 Provide supporting documentation such as NCSOS filing. The permit contact's position must be in accordance
with 15A NCAC 02H .1040(1).
3 If more than one point of contact or mailing address is being changed, please attach a separate sheet.
B. CERTIFICATION OF PERMITTEE
I, William DeForest , the current permittee, hereby notify DEMLR that I am making the
changes as listed in Section A above. I further attest that this application for an update to the permit information currently
on file i curate and complete to the best o y no edge.
Signature: .�, . ; � Date: 54/02o ff
j( ii/e-61 , a Notary Public for the State of ✓ Gr.2> /,/l re-- ,
County of (f ,i i (<;Z✓\--) , do hereby certify that L'e--)l/'1 L (1 h���—
personally appeared before me this the day of ��� , 20 Z3, and acknowledge the due
execution of the forgoing instrument. Witness my hand and official seal,
KATHLEEN G. JONES
(Notary Seal) NOTARY PUBLIC
Union County
North Carolina
My Commission Expires May 4,202?
Notary Signature '
My commission expires — ja 7
Stormwater Permit Information Update Form Page 1 of 1 May 11,2017