NCC191140_Annual Fee Payment Record_20201104

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 11/3/2020 7:19:54 AM (Workflow Start Event)
Submit by Georgoulias, Bethany 11/4/2020 1:30:04 PM (Annual Fee Payment Verification for NCC191140-2020)
* Project closed -out. Notice of Termination approved 1114.
• Georgoulias, Bethany reassigned the task to Georgoulias, Bethany 11/4/2020 1:07 PM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: December 15, 2020 5:00
PM 11/3/2020 7:19 AM

NORTH CAROLINA
Environmental Quvllty
Certificate of NCC191140
Coverage (COC) This is passed fromthe worldlow when the invoice is filed.
No.*
NC Reference COC NCG01-2019-1140
No.*
Permit Status: INACTIVE
Already Rescinded: 11/4/2020
This field appears if the permt has already been termnated.
WAIVE FEE? * r Yes, Payment Not Applicable
f No, Payment Still Applies
Project Name * Blackbridge Subdivision Phase Two Lots 10 and 18
Project Address* Low Oak Ct/Long Lake Dr, Rockfish, NC
Permittee * Caviness Land Development, Inc.
County Cumberland
Invoice No. NCC191140-2020
This is passed fromthe worldlow when the invoice is filed.
Annual Fee * $ 100.00
Invoice Date* 11/3/2020
This is passed fromthe worldlow when the invoice is filed.
Invoice Due Date* 12/3/2020
This is passed from the woMlow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment r Fee Payment Received or Not Applicable.
Received* r Fee Payment NOT RECEIVED.
Date Payment 11/4/2020
Received* Or, if WAN®or NOT FECBV®, this is the date that status is recorded.
e Payme nt
Transaction
Number*
Check Number*
Fee Status* WAIVED

Legally Responsible Watson Caviness
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrodify problem e-rrail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct probleme-nail address or site contact info
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 11/4/2020