NCS000167_Owner Affiliation Change Request_20210106

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/6/2021 4:50:50 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 1/7/2021 9:01:34 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 1/6/2021 4:51 PM

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Default Page
NPDES Permit
Enter your NPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCS000167
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
SUSAN MURPHY
Phone Number*
Reaseenter your phone number
443-493-0786
Any format is fine.
Email Address *
Rease enter a valid a-rrail address
[e-mail]
A confirmation of submssion will be e-mailed to this address.
Need a copy of the Permit Owner Affiliation Designation Form? You must upload a signed copy of that form below.
Questions? Call Bethany Georgoulias at [phone] or e-mail her at.bethany.georgouliasencdenr.gov.
Completed Form Reaseupload the signed "FbrmitCwnerAffiliation Designation Forn1'
Upload* NC STORMWATER PERMIT OWNER AFFILIATION
114.64 KB
DESIGNATION FORM_01062021 SIGNED.pdf
pdt only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCS000167