Loading...
HomeMy WebLinkAboutWQ0036625_More Information (Received)_20190617 Sewer Extension Permit Status Update Permit No.: GI 0031,O1o2.5 Permittee: a 0WA *\\U cS p(Lr Project Name: V 1\\2( e. !+o r e.-S Sem.)Px For multiple permits with the same status,please attach a supplementary page indicating all permit numbers and project names of the permits being addressed by this form. RECEIVED/NCDEQ/BUUR Please complete the applicable remaining portion of this form and return to the Division at: NCDEQ/DWR JUN 17 2019 WQPS—PERCS UNIT Water Quality By U.S. Postal Service: By Courier/Special Delivery: By Email: Permitting Sec l®n 1617 Mail Service Center 512 N.Salisbury St.Suite 925 Nyle Hothem Raleigh,NC 27699-1617 Raleigh, NC 27604 Nyle.Hothem@ncdenr.com *************************************************************************************************** Permit Shall Remain Open We certify that the subject permit(s)has not yet been constructed but shall be constructed in the future in conformity with the approved project plans,specifications,and supporting documents OR that this project is currently under construction but is not yet in operation. We understand that the appropriate certification documents must be forwarded to the Division prior to operation. Please maintain the subject permit(s)in active status. Name&Title(print): Signature: Date: Comments: *************************************************************************************************** Permit Rescission Request We request that the subject permit(s)be rescinded and certify that the permitted sewer(s) have not been and shall not be constructed nor made operational.We understand that,in the future,should we wish to operate a non-discharge sewer system,we shall apply for and receive a new Wastewater Collection System Permit. Name&Title(Print): Yld c'•6. e-Oto( psr �T9. (i P1Gy r '1Signature: W� Date: ttI (I , Comments: C`('Jew rsDk MOB\(\gyp —c0(VQ?1(.6 **************************************************************************************************** Contact Information Updates: To update your contact information,including mailing address,please list that information below: Updated Contact Person: • Updated Mailing Address: Updated Email: