20200435 Ver 1_401 Application_20200402

Staff Review
Does this application have all the attachments needed to accept it into the review process?
r Yes r No
ID#* Version* 1
20200435
Is this project a public transportation project?* r Yes
r No
Is this a DOT r Yes r No
project?*
Reviewer List:*
Select Reviewing Office:*
Submittal Type:*
401 Application
Garcy Ward: eads\gpward
Washington Regional Office - [phone]
Does this project require a request for payment to be sent?*
r
Yes
r
No

Project Submittal Form
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.
Project Type: r
New Project
r
New Project w Existing ID
r
Pre -Application Submittal
r
More Information Response
r
Other Agency Comments
r
For the Record Only (Courtesy Copy)
r
Stream or Buffer Appeal
New Project - Please check the new project type if you are trying to submit a new project that needs an official approval
decision.
Pre -Application Submittal - Please check the pre -application submittal if you just want feedback on your submittal and
do not have the expectation that your submittal will be considered a complete application requiring a formal decision.
More Information Response - Please check this type if you are responding to a request for information from staff and
you have and ID# and version for this response.
Other Agency Comments - Please check this if you are submitting comments on an existing project.
Project Contact Information
Name: Kristi Lynn Carpenter for Gordon Cashin
VVAio is subrritting the inforr ation?
Email Address: [e-mail]
Project Information
Project Name: Replace Bridge 15 on SR 1505
Is this a public transportation project?
r Yes
r No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
TIP#: WBS#:
17BP.1. R.90
(Applies to DOT projects only)
County (ies)
Northampton
Please upload all files that need to be submited.
Oickthe upload button or drag and drop files here to attach document
17BP.1.R.90_CE_Northampton_15.pdf 8.92MB
17BP1R90_PERMITS_WETLANDS_20200103.pdf 1.79MB
Only pdf or krm files are accepted.
Describe the attachments:
original sent via email

Sign and Submit
P 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 the online form."
Signature:
Submittal Date: Is filled in automatically.