NCG160028_Owner Affiliation Change Request_20210316

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/16/2021 1:34:45 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 3/19/2021 10:56:56 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 3/16/2021 1:34 PM

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Default Page
NPDES Permit
Enter your NPD6 storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG160028
NCS)00000(orNQG)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Isaac Rose
Phone Number*
Reaseenter your phone nunber
3368357506
Any format is fine.
Email Address *
Rease enter a valid a -mail address
[e-mail]
A confirmation of submssion will be e-rrailed 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* statesville 0028.pdf 63.55KB
pdf only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG160028