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Home My WebLink AboutNCC222849_NOI Signed Certification_20220810NCGO1 Notice Intent (NOI)Certificat^on Form Print this form, com Then, mail theoriginal form 10the NCDE � � Division ofEnergy, W 512 N. Sal DO NOT MAIL THIS FORM OR PAY certification in any application, record, report, if, Article or a rule implementing this Article ... sh� exceed ten thousand dollars ($10,000). permit, and for any civil or criminal per The information submitted in this NO|i based on myx or gathering he / will abide bvall conditions ufthe N]S Prevention Plan) of the NCG010000 Ge permit are met on the project at all tim F�lI hereby request coverageunder the N( permit will constitute thepermitrequir individual permit. Directions: /|e1e scan and upload tothe electronic NOi NLRStormvvaterProgram (with $1UOcheck /fpaying bvcheck) at: �nera|&Land Resources StormwaterProgram 3buryStreet, 6mFloor (Office 640K) L612Mail Service Center Raleigh, 0C27699'1612 UNTIL YOUR APPLICATION HAS BEEN ACCEPTED AS COMPLETE. who knowingly makes anyfalse statement, representation, or i, or other documentfiled or required to be maintained under this bnctionactivities ofthis project, for satisfying the requirements ofthis |tiesincurred due toviolations ofthis permit, to the best of my knowledge and belief, true, accurate, and complete sons who manaee the system. or those nersons -ol Plan is not compliant with Part 11 (Stormwater Pollution I Permit, I will nonetheless ensure that all conditions of Part 11 of the Project Name (must match Ala): Hemby Bridge Volunteer Fire Department Specific Lot Numbers (must match Alb): Permittee (must match Bl): Hemby Bridge Volunteer Fire Department, Inc Legally Responsible Person (must match B2 �'B3), Johnny Blythe Fire Chief Title of Legally Responsible Person (must match B3b): Name & Title of Signed if Authorized Individual Differs from Legally Responsible Person: Phone Number: 704-882-2100 *IMPORTANTNOTE. This form must be signed by a iresponsible corporate officer that owns oroperates the construction activity, such as a president, secretary, treasurer,orvice prTident,oromanager that isauthorized /naccordance with Part IV, Section B' Item (6)o/the N permit.