NCC200829_Contact Update Record_20210303

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany 3/3/2021 9:30:42 AM (Contact Changes Submitted)

Certificate of NCC200829
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-0829
Original NOI No.* 22454
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new OOC required)
Fayetteville Public Works Commision
Project Name
Maiden Lane Phase 2 Sanitary Sewer and Water Relocation
Address
Maiden Lane, Fayetteville, NC
County
Cumberland
Latitude
35.0550
Longitude
-78.8800
Date COC Issued*
03/16/2020
Prior Rescission
This field will populate only if OOC has already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
r Legally Responsible Individual Only
f Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'torevise Billing Contact details.
Changed?
r No
r Yes
Billing Email
NEW Billing Email misty. [e-mail]
Billing Telephone
No.
NEW Billing [phone]
Telephone No. (Cptional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Joseph Glass
Individual
(Previous)

First Name (New)* Misty M.
Last Name (New) * Manning
NEW Legally Reflects any revisions above
Responsible Misty M. Manning
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee misty. [e-mail]
Email*
Permittee 9102234730
Telephone No.
(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing P.O. Box 1089, 0, Fayetteville, NC 28301
Address (Previous)
NEW Permittee
Mailing Address*
Street Address
P.O. Box 1089
Address Line 2
City
Fayetteville
Fbstal / Zip Code
28301
Permittee Street 955 Old Wilmington Rd, 0, Fayetteville, NC
Address (Previous) 28301
NEW Permittee
Street Address*
Street Address
955 Old Wilmington Rd
Address Line 2
city
Fayetteville
Fbstal / Zip Code
28301
State / Rovince / Fbgion
NC
Country
United States
State / F rovince / Region
NC
Country
United States
Change Requested Misty Manning on 3/2/2021 via Modification Form
by: * Include any additional correspondence records in the Repository CDC folder.
Additional Information for this update to contact information:
Addional Joseph Glass retired.
Explanation
(Optional)
Date * 03/03/2021