20200628 Ver 1_401 Application_20200511 (3)

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
f New Project with Existing ID
r Pre -Application Submittal
f More Information Response
r Other Agency Comments
f For the Record Only (Courtesy Copy)
r Stream or Buffer Appeal
Submittal Type:*
401 Application
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 Amy Euliss
Vft is subaitting the inforrration?
Email Address:* [e-mail]
Project Information
Project Name:* Improvements to Hopkins Road and Big Mill Farm Road (U-5760)
Is this a public transportation project?*
r Yes
r No
Is this a DOT project?
r Yes
r No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
r Yes r No r Unknown

TIPM WBS#:
U-5760 46381.1.1
(Applies to DOT projects only)
County (ies) *
Forsyth
Please upload all files that need to be submited.
Oickthe upload button or drag and drop files here to attach document
Only pdf or kmz files are accepted.
Describe the attachments:
Original submitted via email. Application documents placed straight into Laserfiche.
* rJ 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.*
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Submittal Date: Is filled in autorratically once subnitted.