NCS000584_Owner Affiliation Change Request_20201022

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/22/2020 11:50:03 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 10/30/2020 8:42:46 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 10/22/2020 11:50 AM

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Default Page
NPDES Permit
Enter your NPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCS000584
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Zack MacKenzie
Phone Number*
Rease enter your phone nunber
[phone] ext. 3270
Any format is fine.
Email Address *
Rease enter a valid a -mail address
zcmackenzie@le)angtonnc.gov
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 Rease upload the signed "Fbrnit Cwner Affiliation Designation Forn1'
Upload* NCS000584 Lexington Ownership Change.pdf 119.07KB
pdr only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCS000584