20180198 Ver 1_More Info Received_20200618 (2)

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: * f New Project r New Project with Existing ID
r Pre -Application Submittal r More Information Response
r Other Agency Comments r Stream or Buffer Appeal
r For the Record Only (Courtesy Copy)
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: Lin Xu
Vft is subrritting the inforrration?
Email Address:* [e-mail]
Project Information
Existing ID #:* Existing Version:*
20180198 1
20170001(no dashes) 1
Project Name:* Sassarixa Swamp Mitigation site
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
County (ies) *
Johnston
Please upload all files that need to be submited.

cickthe upload button or drag and drop files here to attach document
Sassarixa401 COfffice_ApplicantCorrectionRequest... 306KB
20180198 Vert 401
76K6
Appl ication_20200520_Corrected. pdf
Only pdf or Iv17 files are accepted.
Describe the attachments or add comments:
* 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:*
lk��reAWK
Submittal Date: Is filled in autorratically once subnitted.

2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3.Applicant Information (if different from owner)
2f. Fax Number:
-----------------------------------------
3a. Name:
Lin Xu
3b. Business Name:
NCDEQ-DMS.
3c. Address
Slreel Add"ess
217 W Jones Street
Add"ess l..re2
Suite 3000A
aty
Raleigh
RlstallZipQJde
27603
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Angela Allen
4b. Business Name:
Wildlands Engineering, Inc.
4c. Address
Slreel Add"ess
312 West Millbrook Road
Add"ess l..re2
Suite 225
aty
Raleigh
Rlstal I Zip QJde
27609
4d. Telephone Number:
[phone]
4f. Email Address:*
aallen@'Mldlandseng.com
Agent Authorization Letter*
LOA+ TaxParcels.pdf
C.Project Information and Prior Project History
1.Project Information
1 b. Subdivision name:
1c. Nearest municipality /town:
Four Oaks
2.Project Identification
Stael A-oorrel �
NC
Omry
us
3e. Fax Number:
Stael A-c,;incel R,gia,
NC
Omry
us
4e. Fax Number:
2.38MB
A
June 18, 2020
Erin Davis, Stream & Wetland Mitigation Specialist
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699 - 1617
Re: Request for modification of applicant information - Sassarixa Swamp Mitigation Site
Mitigation Project, Johnston County (DMS Full Delivery Project)
Dear Ms. Davis:
DMS is requesting to change the applicant information from full delivery provider, Wildlands
Engineering, to DMS. This request letter along with corrected form have been uploaded to NC
DWR’s file system. Please feel free to contact me with any questions regarding this request
(919-707-8319).
Thank you very much for your assistance.
Sincerely
Lin Xu
Attachment: 404/401 Permit Application Package
Permit Application Fee Memo
Lin Xu