NCC201244_Contact Update Record (Site Contact)_20230320

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by bethany.georgoulias 3/20/2023 11:05:07 AM (Contact Changes Submitted)

Certificate of
NCC201244
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2020-1244
Original NOI No.*
23390
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Leoterra Skeet Club, LLC
Project Name Waterford Springs S/D
Address 3630 Village Springs Drive, High Point, NC
County Guilford
Latitude 36.0418
Longitude-79.9751
Date COC Issued * 03/27/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? Q No
0 Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Christopher Lyons
Individual (Previous)
First Name (New)* Christopher
Last Name (New) * Lyons

NEW Legally Reflects any revisions above
Responsible Christopher Lyons
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 3608 West Friendly Avenue, Suite 202,
Address (Previous) Greensboro, NC 27410-4833
NEW Permittee Street Address
Mailing Address* 110-A Shields Park Drive
Address Line 2
City
State / Province / Region
Kernersville
NC
Postal / Zip Code
Country
27284
US
Permittee Street 3608 West Friendly Avenue, Suite 202,
Address (Previous) Greensboro, NC 27410-4833
NEW Permittee Street Street Address
Address * 110-A Shields Park Drive
Address Line 2
City State / Province / Region
Kernersville NC
Postal / Zip Code Country
27284 US
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Clyde Lambert
(Previous)
Site Contact Title CONSTRUCTION MANAGER
(Previous)
Organization Leoterra Development
(Previous)
First Name (New)* Kat
Last Name (New) * Lyons
NEW Site Contact* Reflects any revisions above
Kat Lyons

NEW Site Contact Senior Director of Entitlements
Title
NEW Organization LeoTerra Development Inc.
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 336-858-8735
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 3608 West Friendly Avenue, Suite 202,
Address (Previous) Greensboro, NC 27410-4833
NEW Site Contact Street Address
Mailing Address* 110-A Shields Park Drive
Address Line 2
City
State / Province / Region
Kernersville
NC
Postal / Zip Code
Country
27284
us
Change Requested Jason Cheek via email requesting site contact updates on 3/10/2023. Address for
by: * current legally responsible individual updated.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 03/20/2023