Norris Farm - 11/26/2018 11:15:14 AM

Submittal Dated: 11/26/2018
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Existing Project Information:
Rease supply the perrrit nunber for this project.
D# * FL-rrrit Narrber
SW6181003
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Norris Farm
County: Harnett
Name: Fleet Temple
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach document
DEED - DB3615-PG162.pdf
139.6KB
Deed Restrictions and Protective Covenants.pdf
108.88KB
LLC Certification. pdf
37.45KB
Low Density Supplement.pdf
310.4KB
Stormwater Management Permit Application.pdf
530.38KB
USGS Quad Map.pdf
98.85KB
Only pdf files are accepted.
Describe the attachments:
Current Deed of the Property
Deed Restrictions and protective covenants
LLC Certification from Secretary of State
Low Density Supplement
Stormwater Management permit application
USGS Quadrangle map of site
* V By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
• I agree that submission of this Supplemental Information form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act)
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');

o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Peter E Norfleet Temple
Signature:
Date Submitted: 11/26/2018

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW6181003
Who needs a V Central Office
copy?* rJ Regional Office
Central Office Reviewer:
Corey Anen - eads\scanen
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Select RO Reviewer:*
[e-mail]