20180654 Ver 1_401 Application_20180514

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 5/14/2018 1:05:12 PM (Message Start Event)
Accept by Carpenter,Kristi 5/14/2018 1:06:22 PM (DOT project)
. The task was assigned to Carpenter,Kristi. The due date is: May 17, 2018 5:00 PM 5/14/2018 1:05 PM

Water Resources
ENVIRONMENTAL �UPLITV
Staff Review
ID#* Version* �
20180654
Is this project a public transportation project? * �' Yes
�' No
Reviewer List:* Garcy Ward:eads\gpward
Select Reviewing Office:* Washington Regional Office -[phone]
Submittal Type:*
401 Application
Does this project require a request for payment to be sent? *
l'
Yes
r•
No

Project Submittal Dated 5/14/2018
*
Please note: fields marked with a red asterisk beloware required. You will not be able to submit the form until all
mandatory questions are ans�red.
Project Type:* �' New Project
C' Pre-Application Submittal
C' More Information Response
r Other Agency Comments
l' 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 e�ectation 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 ebsting project.
Project Contact Information
Name: Kristi Lynn Carpenter for Clement Riddle
Who is subrritting the irrforrration?
Email Address:* [e-mail]
Project Information
Project Name:* Plymouth Municipal Airport (PMZ) - Construct Connector Taxiways & Improvements
Is this a public transportation project? *
C•' Yes
C' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C' Ye�" No �' Unknown
TI P#: WBS#:
(Applies to DOT projects only)
County (ies) *
Washington
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach docurrent
Plymouth Municipal Airport (PMZ) - Construct
12.36MB
Connector Ta�aways & Improvements.pdf
Only pdf or Ivrz files are accepted.
Describe the attachments:
Application submitted on paper. Submitting through electronic process on behalf of applicant.
* �J By checking the box and signing box below, I certify that:
o I have niven true_ ar.curate_ and cmm�lete informatinn nn this fnrm�

_, ____.___, _.._ __...�.--- ...._....__._.. _.. _..._ ._....,
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 online form."
Signature:
: � �rrr u��rrr C'o�t,c�rrr
Submittal Date: