NCC193032_Annual Fee Payment Record_20230109

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 11/29/2022 12:39:02 PM (Workflow Start Event)
Submit by Holloman, Tevye L 1/9/2023 9:22:51 AM (2022 Annual Fee Payment Verification for NCC193032-2022)
0 DEVELOPMENT KISCO SENIOR LIVING
Holloman, Tevye L assigned the task to Holloman, Tevye L 1/9/2023 9:21 AM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: January 10, 2023 5:00
PM 11/29/2022 12:39 PM

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NORTH CAROLINA
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Certificate of
NCC193032
Coverage (COC) No. *
This is passed from the workflow when the invoice is filed.
NC Reference COC
NCG01-2019-3032
No. *
Permit Status:
Active
Year COC Issued
2019
This field will be hidden.
Check previous years for outstanding fees (years that do not apply will be blank):
2020 Fee Status
PAID
2021 Fee Status
PAID
Project Name*
The Pilot at Sedgefield - Water and Sewer Improvements
Project Address*
5300 High Point Road, Greensboro, NC
Permittee*
KSL Sedgefield Pilot, LLC
County
Guilford
Invoice No.*
NCC193032-2022
This is passed from the workflow when the invoice is filed.
Annual Fee*
$ 100.00
Invoice Date*
12/1/2022
This is passed from the workflow when the invoice is filed.
Invoice Due Date*
1/1/2023
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.
Days Overdue
8
Wait at least 15 days until proceeding to NOD.
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
1/9/2023
Received *
Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.

Method of Payment* electronic
check
other
ePayment 670371097
Transaction Number*
Fee Status* PAID
Legally Responsible Mitch Ritschel
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 [e-mail]
(If available)
CONFIRM Billing E- [e-mail]
mail Opportunity to correct problem e-mail address or billing contact info
Billing Telephone No. [phone]
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
[e-mail]
for 30-day Reminder
This is the email for the 30-day reminder if needed (passed from workflow).
Project Name for 30-
The Pilot at Sedgefield - Water and Sewer Improvements
day Reminder
The project name is passed from workflow for the 30-day reminder
Permittee Name for
KSL Sedgefield Pilot, LLC
30-day Reminder
The permittee is passed from workflow for the 30-day reminder
County for 30-day Guilford
Reminder The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date* 1/9/2023