NCG190015_Renewal COC Request_20201122 9:28:03 AM

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/22/2020 9:28:02 AM (COC Request Submission)

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG190015
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Timothy A Moon
Obtaining COC*
First and Last Name
Phone Number* 9105796440
Email * [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional email address to whom to send the CDC
Did you check the permit COC file in our repository to ensure this COC was not already available from a previous
request? If it is, please obtain it from there instead of this form.
V Yes, this COC was not already there.
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General
NCG190000
Permit No.
COC No.
NCG190015
Permittee
T J M Ocean Isle Partners LLC
Facility Name
Ocean Isle Marina & Yacht Club
Address
2000 Sommersett Rd SW
City
Ocean Isle Beach
County
Brunswick
Waterbody
Intracoastal Waterway
Classification
SA;HQW
River Basin
Lumber
RENEWAL STATUS
Active
Issuance Date*
10/01/2020
Effective Date
10/01/2020
Effective Date
20201001
Reformatted
I hereby request a copy of the Certificate of Coverage (COC) entered above. I understand that the COC e-mailed as a

result of this request will serve as the Permittee's record of renewed coverage under the General Permit, and that this
record must be maintained with the Permittee's NPDES Stormwater Permit records.
In addition, 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"); and 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");
Signature *
Date * 11 /22/2020