NCC192612_Contact Update Record_20201204

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Georgoulias, Bethany 12/4/2020 5:45:39 PM (Contact Changes Submitted)

Certificate of NCC192612
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2019-2612
Original NOI No.* 17935
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
SDH Charlotte LLC
Project Name
Dogwood Forest
Address
1904 John Moore Road, Monroe, NC
County
Union
Latitude
35.0230
Longitude
-80.5900
Date COC Issued*
11/01/2019
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
r Legally Responsible Individual Only
Have Changed?*
f Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible
Ron Willing
Individual
(Previous)
First Name (New)*
Emily
Last Name (New) *
Powell
NEW Legally
Peflects any revisions above
Responsible
Emily Powell
Individual*
Permittee Email
[e-mail]
(Previous)
NEW Permittee
[e-mail]
Email *

Permittee 704-808-1132
Telephone No.
(Previous)
NEW Permittee 704-575-9310
Telephone No.*
Permittee Mailing PO Box311, 0, Midland, NC 28107
Address (Previous)
NEW Permittee Street Address
Mailing Address* PO Box311
Address Line 2
City
State / Rovince / Fbgion
Midland
NC
Fbstal / Zip Code
Country
28107
USA
Permittee Street 4297B NC Highway 24/27, 0, Midland, NC
Address (Previous) 28107
NEW Permittee Street Address
Street Address* 4297 NC Highway 24/27
Address Line 2
Suite B
aty
State / Rovince / Region
Midland
NC
Fbstal / Zip Code
Country
28107
USA
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Ron Willing
(Previous)
Site Contact Title Land Development Manager
(Previous)
Organization SDH Charlotte LLC
(Previous)
First Name (New)* Emily
Last Name (New) * Powell
NEW Site Contact* Reflects any revisions above
Emily Powell
NEW Site Contact VP of Land Acquisition
Title
NEW Organization SDH Charlotte LLC
This field is not required on the NO form and rray not pre -populate.
Site Contact Email [e-mail]
(Previous)

NEW Site Contact [e-mail]
Email *
Site Contact 704-808-1132
Telephone No.
(Previous)
NEW Site Contact 704-575-9310
Telephone No.*
Site Contact Mailing PO Box311, 0, Midland, NC 28107
Address (Previous)
NEW Site Contact Street Address
Mailing Address* PO Box311
Address Line 2
City
State / Frovince / Region
Midland
NC
Rbstal / Zip Code
Country
28107
USA
Change Requested Emily Powell via Modification request submitted 4/20/2020.
by: * Include any additional correspondence records in the Repository CCiCfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 12/04/2020