Loading...
HomeMy WebLinkAboutNCG190009_Permit Contact Update Request_20230621 Action History (UTC-05:00)Eastern Time(US&Canada) Submit by Anonymous User 6/21/2023 2:35:13 PM (Permit Contact Update Request) Approve by Joyce Sanford 7/26/2023 1:25:33 PM (Contact Update Review) • The task was assigned to DEMLR SW Admin General.The due date is:August 2,2023 5:00 PM 6/21/2023 2:35:21 PM • The task was assigned to Joyce Sanford by round robin distribution 6/21/2023 2:35:21 PM DEQIwo NPDES Stormwater -Request Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number. Number* NCG190009 Begins with NCS,NCG,or NCGNE(no exposure) Facility Name* Creekside Yacht Club-Bradley Creek (Used to verify permit number) Check permit contact information for your permit by running a Stormwater Permit Summary Report. Guidance for COC holders: Do not enter the General Permit number with all 0's(for example, NCG030000)but instead your Certificate of Coverge(COC)number. Check all that Owner Affiliation(Legally Responsible Individual)Update * apply: Permit Ownership Transfer or Facility Name Change Delegation of Signature Authority(DOSA) Permit Contact Update Billing Contact Update Facility Contact Update Other Contact Update Person(s) with Delegation of Signature Authority (DOSA) Delegation of Please upload the signed"Stormwater Permit Delegation of Signature Authority Form" Signature Authority NCG190009 DOSA Creekside Yacht Club 2.73MB 06.2023.pdf pdf only Submitter's Name* Please enter your FIRST and LAST name Howard Stanley Phone Number* Please enter your phone number 910-350-0023 Any format is fine. Email Address* Please enter a valid e-mail address howard@creeksideyachtclub.com A confirmation of submission will be e-mailed to this address. * By checking the box and signing below, I certify that: I have given true,accurate,and complete information on this form; I agree that submission of this form is a"transaction"subject to Chapter 66,Article 40 of the NC General Statutes(the "Uniform Electronic Transactions Act"); I agree to conduct this transaction by electronic means pursuant to Chapter 66,Article 40 of the NC General Statutes(the "Uniform Electronic Transactions Act"); I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature(except for any uploaded Owner Affiliation Change or Delegation of Signature of Authority forms,which also must be mailed in with original signature);AND I intend to electronically sign and submit this Permit Contact Update Request form. Signature Date 6/21/2023 Questions? Contact bethany.georgoulias@deq.nc.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCG 190009