20191337 Ver 2_Modifications_20200723

Staff Review
Does this application have all the attachments needed to accept it into the review process?*
r Yes r No
ID#* Version* 2
20191337
Is this project a public transportation project?* r Yes
r No
Is this a DOT r Yes r No
project?*
Reviewer List:* Donna Hood:eads\drhood
Select Reviewing Office:* Mooresville Regional Office - [phone]
Submittal Type:* Modifications
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 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: Kristi Lynn Carpenter for Michael Turchy
Who is subrritting the infornation?
Email Address: [e-mail]
Project Information
Existing ID #: Existing Version:
20191337 1
20170001(no dashes) 1
Project Name: 1-485 Express Lanes (1-5507)
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#:
1-5507
County (ies)
Mecklenburg
WBS#:
43609.3.2
(Applies to DOT projects only)
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
1-5507 Renewal and Mod Mecklenburg July 23
7.92MB
2020. pdf
Only pdf or krre files are accepted.

Describe the attachments
or comments:
Original modification request 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:
,-�—Il ? 41Wle 4�-:11? B.
Submittal Date: Is filled in automatically.