Tumbleweed Terrace PTC Transfer Request»gi3ign veruiecu:
WYOMING DEPARTMENT OF ENVIRONMENTAL QUALITYMATER QUALITY DIVISION
Chapter 3 PERMIT TO CONSTRUCT TRANSFER REQUEST
Water Quality Division, Department of Environmental Quality Date ICS 2Dzl
200 W. 17th St.- 4th Floor
Cheyenne, WY 82002
Phillip D. HUCkins intends to transfer ownership of the facility
(Original Owner of Record )
Tumbleweed Terrace Site Development - sanitary sewer main extension associated with Permit # 2020-12
(Facility Name or description)
to City of Sheridan
(New Owner of Record)
, on 3 248Zo ZZ
(Date)
It is requested that the said permit be transferred to the new owner in accordance with Section 12 of Chapter 3,
Wyoming, Water Quality Rules and Regulations. The new owner agrees to accept and be bound by the
provisions of the new (transferred) permit and any amendments, agrees to construct and operate the facility in
accordance with the approved permit, and agrees to accept responsibility for the facility's compliance with
applicable standards and permit conditions, including the responsibility to perform any necessary corrective
actions.
The original owner shall retain responsibility for the facility according to the terms of the original permit until the
application for permit transfer is approved by the Administrator.
//1k Y -iw*:- 10-11-2021 10:21 AM MDT
Signature of Original Owner's Representative
(A certified copy of a recorded document transferring
ownership of the real estate may be accepted in lieu of
the signature of the original owner.)
Name and Title Phillip D. Huckins
(Please Print)
Company Name _n/a
Address 214 Beaver Creek Road
Sheridan, WY 82801
Telephone 307-751-5555
LBH/bb/10-0001.DOC
Revised 1/4/2010
Signature of New Own is Representative
Name and Title V\
S l (2C4-Ov—
(Please Print)
Company Name City of Sheridan
Address 55 Grinnell Plaza
Sheridan, WY 82801
Telephone 307-674-6483