WSCO_HALI_WSWP Submittal Review_20210115

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/14/2021 4:16:43 PM (Supplemental Submittal)
Approve by Clark, Paul 1/15/2021 10:17:59 AM (WSW Program Info Submittal Review)
p Thank you very much for the response. 1 will contact you with any questions, updates, etc. thx again.
paul
• The task was assigned to Clark, Paul. The due date is: January 28, 2021 5:00 PM 1/14/2021 4:16 PM

d� #
NORTH CAROLINA
Ernvlronmental qualily
Submittal Dated: 1/14/2021
Water Supply Watershed Protection Program Info
Rease supply the information below
County:*
What Type of
Program?*
Halifax
f Municipality
IT County
Choose additional counties if applicable:
Additional County:
WSW Program WSCO_HALI
Identifier:* Auto -populated from choices above
Name of Submitter:* Chris Rountree
Vft is subrritting this inforrration?
Title:* Director, Planning/Zoning/Inspections
Email:* [e-mail]
Telephone:* 12525831082
Map:
Cickthe upload button or drag and drop files here.
Only pdf files are accepted.
The current version
Cickthe upload button ordrag and drop files here.
of your WSWP
WSWP Halifax County.pdf
ordinance(s):
Only pdf files are accepted.
Other information:
Cickthe upload button ordrag and drop fileshere.
Only pdf files are accepted.
Describe the
attachments:
1.29MB
rJ By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o 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');
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 this form."
Full Name:* Chris Rountree
Signature
�tr�C-tom'•
Date Submitted 1/14/2021
Submittal Date 20210114
Formatted

Review
Program Entity: Halifax
Edit if necessary
Verify Primary Halifax
County * Update county if needed.
Verify WSW ID* Halifax Co (WSCO_HALI)
Update ID if needed.
Review Date 01/15/2021