NCG050282_Owner Affiliation Change Request_4/23/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/23/2020 11:59:30 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 4/23/2020 12:11:04 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 4/23/2020 11:59 AM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG050282
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Terry Brosi
Phone Number*
Reaseenter your phone nunber
919*-440-1172
Any format is fine.
Email Address *
Rease enter a valid e-rmil address
[e-mail]
A confirmation of submssion will be e-mailed to this address.
Need a copy of the Permit Owner Affiliation Designation Form? You must upload a signed copy of that form below.
Questions? Call Bethany Georgoulias at [phone] or e-mail her at.bethany.georgouliasencdenr.gov.
Completed Form Reaseupload the signed "FbrnitCwnerAffiliation Designation Fornl'
Upload* New owner affiliation Woodland.pdf 700.29KB
pdr only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG050282