20170848 Ver 1_401 Application_20170811

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 8/11/2017 8:17:17 AM (Supplemental Submital)
Accept by Carpenter,Kristi 8/11/2017 12:34:04 PM (DOT project)
• The task was assigned to Carpenter,Kristi 8/11/2017 8:17 AM

Water Resources
ENVIRONMENTAL OUALITY
Staff Review:
Submittal Type: C•' New Project
C' Pre-Application Submittal
C' More Information Response
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.
ID#* Version*
20170848 1
Reviewer List:* Dave Wanucha:eads\djwanucha
Select Reviewing Office:*
Winston-Salem Regional Office - [phone]
Project Submittal Interim Form
subrritted: 8/11/2017
Project Contact Information:
Name: Marla Chambers
Who is subrritting the inforrration?
Email Address: [e-mail]
Project Information:
Project Name: Wilkes Co. Bridges #403 &#700 permit
application
Is this a public transportation project?
l•' Yes
C' No
TI P#:
WBS#: 17BP.11. R.120
(Applies to
DOT projects
only)
County (ies) *
Wilkes

County(ies)*
Describe the attachments:
NCWRC has no comment on the subject project. We are not requesting a trout moratorium. No attachment
included.
Please upload all files that need to be submited.
Only pdF files are accepted.
r% By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o 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 AcY')
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions AcY');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the form.
Signature:
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