20171086 Ver 1_SR 1353, Hardin Road_20171006

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/6/2017 2:42:27 PM (Supplemental Submital)
Accept by Carpenter,Kristi 10/6/2017 5:07:05 PM (DOT - E�asting Project)
• The task was assigned to Carpenter,Kristi 10/6/2017 2:42 PM

Water Resources
ENVIRONMENTAL OUALITY
Staff Review:
Submittal Type: l" 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#*
20171086
Version*
1
Is this project in a CAMAAEC area?* �' Yes
�' No
Reviewer List:*
Select Reviewing Office:*
Dave Wanucha:eads\djwanucha
Winston-Salem Regional Office - [phone]
Project Submittal Interim Form
subrritted: 10/6/2017
Project Contact Information:
Name: Marla Chambers
Who is subrritting the inforrration?
Email Address: [e-mail]
Project Information:
Project Name: SR 1353, Hardin Road
Is this a public transportation project?
C' Yes
l' No
TI P#:
WBS#: 11 C.095122
(Applies to
DOT projects
only)

County(ies)*
Watauga
Describe the attachments:
We do not object to the project and are not requesting a work moratorium. We encourage minimization of tree
removal. (No document uploaded)
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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