Water Supply Watershed E-Submittal Form

Water Supply Watershed Protection Program Info

Please supply the information below

Fields marked with a red asterisk* are required. You will not be able to submit the form without answering these questions.
County:*field type drop-down
What Type of Program?*field type radio button
What Type of Program?MunicipalityCounty
Municipality:*field type drop-down
Choose additional counties if applicable:
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- Additional County:field type drop-down
Add
WSW Program Identifier:*field type single line
Auto-populated from choices above
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Name of Submitter:*field type single line
Who is submitting this information?
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Title:*field type drop-down
Email:*field type email
Telephone:*field type single line
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Map:field type file upload
Click the upload button or drag and drop files here.
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Only pdf files are accepted.
The current version of your WSWP ordinance(s):field type file upload
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Only pdf files are accepted.
Other information:field type file upload
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Only pdf files are accepted.
Please describe:field type multi line
*field type checkbox
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 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 this form.”
Full Name:*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Signature*field type signature
Date Submittedfield type date
Date will be captured on form submission
County Pre-Selected for Reviewerfield type drop-down
WSW ID Pre-Selected for Reviewerfield type drop-down
Program Entity for Email/Metadatafield type single line
Input blocked. Maximum character limit of 4000 characters reached.