SW4190301_Supplemental Info Review_7/9/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/9/2019 5:10:55 PM (Supplemental Submittal)
Submit by Strickland, Shane 7/10/2019 12:00:17 PM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 7/9/2019 5:10 PM

Submittal Dated: 7/9/2019
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
SW4190301
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Mountain Park Elementary School
County: Surry
Name: Lisa Meadows
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Oick the upload button or drag and drop files here to attach document
MtPark- Stormwater Management Permit_Signed.pdf 2.28MB
Only pdf files are accepted.
Describe the attachments:
Revised permit application
* V By checking the box and signing box below, I certify that:
• 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');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
• I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Lisa Meadows
Signature:
Date Submitted: 7/9/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW4190301
Who needs a V Central Office
copy?* F Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Winston-Salem Regional Office — 336-776-
9800
Select RO Reviewer:*
[e-mail]