NCG020931_Supplemental Upload Submittal Form_5/25/2018

Supplemental Information Upload Form
Please note: fields mark ed with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
ID#*
Ve rsion:*
Facility Name :*
County:
Name :
Email Addre ss:*
Ple ase upload all file s that ne e d to be submite d.
De scribe the attachme nts:
*
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 :*
Existing Project Information:
If it is an existing project, please supply the DWR#.
SW Permit Number
SW0000000
9 digits - example SWxxxxxxx
1
Whitley Borrow Pit (NCG020931)
Johnston
T. Patrick Shillington
Who is submitting the information?
[e-mail]
Click the upload button or drag and drop files here to attach document
Sheet 1- Stormwater Plan.pdf 963.57KB
Only pdf files are accepted.
Stormwater Plan Drawing
By
checking
the
box
and
signing
box
below,
I
certify
that:
Thomas Patrick Shillington
Signature :*
Date Submitte d: