NCC203424_NOI Signed Certification_20200813

NCGO1 Notice of Intent (NOI} Certification Form
Directions:
- - _1!1 _:_ - crel4 fbc, c _ °)at:
=—y Ss:+- A Street E _ _ =1
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DO NOT MAI THIS FORM OR PAYMENT UNTIL YOUR APPLICATION HAS BEEN
REVIEWED AND ACCEPTED AS COMPLETE
ii &atilt- _ - t -_4.- _boxes t_ e �_� l....i r agreement):
_fir` for the comtruction a .et es of this project,for sairm,4Ing the
and for any civg or penalties incurred due to violations of this
11 -_ _`_ .= —"ed in this NOI is,to the best ^y know ge and belies true,,accurate,and
____-=__ _- . -_ of the pe-_- ; __ __ 'ir ho manage the system,or those persons
: -a e _ e the n =e:uZ;--
-11 wiE abate b. = M of the NC6O10000 General Permit and the approved Erosion and
if the aped Erman and Sediment Control Plan is not compliant with Part II(Stormwater Pollution
Preientibn Plan)of the M�-01 General Permit,l will nonetheless ensure that all conditions of
/ art II of the permit are err on ii�e project at all times
/ I herebvrat coverage under the NICGO10000 General Permit and understand that coverage under
this permit will cute the permit requirements for the discharge(s)and is enforceable in the
- _- as an individual permit.
1.-r- > ?.fit c t. i 'Zeit
:FL -pc +OrganisationalEnd= P41..`1
___- - _:_€eisson:
1`rtie c Legally Re ible Person: I- all -
birs�<c_
Phone Number tik6itivyci -1(h J
thfPORTANT NOTE: This farm must he signed by a responsible corporate c =_r that owns or operates the
- , t:-_ _`>SLOCh as a Ares nt,secretory,usurer,or vice r: =,_ or a manager that is
____ __- ;r--- = t IV Se='_n B Item(6)of the NCG010000 permit.
-_- ---_ _ _ _-_ __ ___-. _-_Edit;,,see Port IV,Section 8,kern(6)of the NCGO1COCO permit