CREEK VALLEY CHASE - 3/6/2019 4:43:34 PM

Submittal Dated: 3/6/2019
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
SW6190103
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* CREEK VALLEY CHASE
County: Hoke
Name: PENNY MARKLE
Who is subnitting the inforrration7
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
2019-03-06-REV.pdf 337.3KB
REV-004-DRAINAG E. pdf 477.37KB
REV-006-PPROF ILE. pdf 465.36KB
REV-007-PPROFILE.pdf 562.98KB
Only pdf files are accepted.
Describe the attachments:
Hard copies of the revised items will be dropped off this week to your office. Thank you
* 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)
• 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:* Penny Markle

Signature:
Date Submitted: 3/6/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW6190103
Who needs a V Central Office
copy?* r- Regional Office
Central Office Reviewer:
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Select RO Reviewer:*
[e-mail]