Neills Creek Tennis Courts - 11/7/2018 10:06:09 AM

Submittal Dated: 11/7/2018
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.
Existing Project Information:
Rease supply the perrrit nunber for this project.
D# * FL-rrrit Narrber
SW6181101
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Neills Creek Tennis Courts
County: Harnett
Name: Raymond Bentley Ruggles
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach document
Neills Creek Park Tennis Courts Low Density
22.11 MB
Stormwater Report 10.26.2018.pdf
2018.10.26-Neills Creek Tennis Courts- Signed
17.73MB
Permit Plans.pdf
Only pdf files are accepted.
Describe the attachments:
Stormwater report and plans as requested.
* V By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
• I agree that submission of this Supplemental Information 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');
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 Supplemental Information form."
Full Name:* Raymond Bentley Ruggles

Signature:
Date Submitted: 11/7/2018

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW6181101
Who needs a V Central Office
copy?* rJ Regional Office
Central Office Reviewer:
Rick Riddle - eads\rlriddle1
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Select RO Reviewer:*
[e-mail]