NCC203843_Annual Fee Payment Record_20220923

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 8/31/2022 12:52:24 PM (Workflow Start Event)
Submit by Clark, Paul B 9/23/2022 5:29:17 PM (2022 Annual Fee Payment Verification for NCC203843-2022)
0 COC rescinded
• Clark, Paul B assigned the task to Clark, Paul B 9/23/2022 5:27 PM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: October 12, 2022 5:00
PM 8/31/2022 12:52 PM

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Certificate of NCC203843
Coverage (COC) No. * This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2020-3843
No. *
Permit Status: INACTIVE
Already Rescinded: 9/23/2022
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* 2019 Water System Improvements (CN 245 & 246)
Project Address* NCSR 1002 & 1226, Fork, INC
Permittee* Fork Township Sanitary District
County Wayne
Invoice No.* NCC203843-2022
This is passed from the workflow when the invoice is filed.
Annual Fee* $ 100.00
Invoice Date* 9/1/2022
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 10/1/2022
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 9/23/2022
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 Braswell
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- 2019 Water System Improvements (CN 245 & 246)
day Reminder The project name is passed from workflow for the 30-day reminder
Permittee Name for Fork Township Sanitary District
30-day Reminder The permittee is passed from workflow for the 30-day reminder
County for 30-day Wayne
Reminder The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 9/23/2022