NCC203612_Annual Fee Payment Record_20220803

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 7/28/2022 9:05:53 PM (Workflow Start Event)
Submit by Clark, Paul B 8/3/2022 3:02:09 PM (2022 Annual Fee Payment Verification for NCC203612-2022)
F COC has been rescinded
• Clark, Paul B assigned the task to Clark, Paul B 8/3/2022 3:01 PM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: September 8, 2022 5:00
PM 7/28/2022 9:05 PM

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NORTH CAROLINA
Envlrmmm(af Quafhy
Certificate of
NCC203612
Coverage (COC) No. *
This is passed from the workflow when the invoice is filed.
NC Reference COC
NCG01-2020-3612
No. *
Permit Status:
INACTIVE
Already Rescinded:
8/3/2022
This field appears if the permit has already been terminated.
Year COC Issued
2020
This field will be hidden.
Check previous years for outstanding fees (years that do not apply will be blank):
2020 Fee Status
2021 Fee Status
PAID
WAIVE FEE? *
• Yes, Payment Not Applicable
No, Payment Still Applies
Project Name*
Carthusiast
Project Address*
10459 INC HWY 50, Pleasant Grove Township, NC
Permittee*
Henry Van Pala
County
Johnston
Invoice No.*
NCC203612-2022
This is passed from the workflow when the invoice is filed.
Annual Fee*
$ 100.00
Invoice Date*
8/1/2022
This is passed from the workflow when the invoice is filed.
Invoice Due Date*
9/1/2022
This is passed from the workflow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment • Fee Payment Received or Not Applicable.
Received* Fee Payment NOT RECEIVED.
Date Payment 8/3/2022
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.

ePayment
Transaction Number*
Check Number*
Fee Status* WAIVED
Legally Responsible Henry Van Pala
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail* Opportunity to modify problem e-mail address or permittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail* Opportunity to correct problem e-mail address or site contact info
Original Billing E-mail (if available)
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone No.
Permittee Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow).
Site Contact Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow)
Billing Contact Email This is the email for the 30-day reminder if needed (passed from workflow).
for 30-day Reminder
Project Name for 30- Carthusiast
day Reminder The project name is passed from workflow for the 30-day reminder
Permittee Name for
Henry Van Pala
30-day Reminder
The permittee is passed from workflow for the 30-day reminder
County for 30-day
Johnston
Reminder
The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 8/3/2022