Norris Farm - 11/6/2018 11:08:31 AM

Submittal Dated: 11/6/2018
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
SW6181003
Exarrples: SWxxxxxxx, NOGxxxxxx, or NCSaxxxx
Facility Name:* Norris Farm
County: Harnett
Name: Fleet Temple
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
S-1.pdf
1.52MB
S-2.pdf
2.29MB
S-3.pdf
1.9MB
S-4.pdf
3.05MB
S-5.pdf
2.41 MB
S-6.pdf
1.82MB
S-7.pdf
1.98MB
SWU-101 Application - Page 3.pdf
106.3KB
Low Density Supplement - Pages 1-2.pdf
142.43KB
Deed Restrictions and Protective Covenants.pdf
109.12KB
Only pdf files are accepted.
Describe the attachments:
Revised Plans
Revised SWU-101 - Page 3
Revised Low Density Supplement - Pages 1-2
Revised Deed Restrictions and Protective Covenants
* V-J 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 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');
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Peter Edward Norfleet Temple
Signature:
cl rrsF r�xrerat f��" jrfrisr�.rrr�a�i
Date Submitted: 11/6/2018

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW6181003
Who needs a V Central Office
copy?* rJ Regional Office
Central Office Reviewer:
Corey Anen - eads\scanen
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Select RO Reviewer:*
[e-mail]