20171356 Ver 1_Initial Review Form_20171025

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Strickland, Bev 10/25/2017 9:11:55 AM (Supplemental Submital)
Accept by Strickland, Bev 10/25/2017 9:13:39 AM (DOT project)
• Strickland, Bev reassigned the task to Strickland, Bev 10/25/2017 9:13 AM
• The task was assigned to Carpenter,Kristi 10/25/2017 9:12 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*
20171356 1
Is this project in a CAMAAEC area?* �' Yes
�' No
Reviewer List:* April Norton:eads\arnorton
Select Reviewing Office:* Central Office -[phone]
Project Submittal Interim Form
subrritted: 10/25/2017
Project Contact Information:
Name : Who is subrritting the irrforrretion?
Email Address: [e-mail]
Project Information:
Project Name: GTCC road Ext
Is this a public transportation project?
C' Yes
l' No
TI P#:
WBS#: (Applies to
DOT projects
only)
County (ies) *
Guilford

Describe the attachments:
Please upload all files that need to be submited.
GTCC Road Extension - GTCC Road Extension 20171356.pdf 7.65MB
Only pdf files are accepted.
rJ 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:
�L'