Line 118 Retrofit - Piedmont Natural Gas - 5/24/2019 3:56:00 PM

Submittal Dated: 5/24/2019
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
SW3190504
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Line 118 Retrofit - Piedmont Natural Gas
County: Union
Name: Neal Tucker
Who is subrritting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Oick the upload button or drag and drop files here to attach document
18-147 Line 118 Stormwater submittal 1.pdf 2.2MB
Davis Subdivision Plat.pdf 434.09KB
Stormwater exhibit.pdf 702.67KB
Only pdf files are accepted.
Describe the attachments:
Line 118 stormwater Submittal package
stormwater plan
recorded plat
* W By checking the box and signing box below, I certify that:
• 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');
• 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:* J. Neal Tucker

Signature:
-191�eAle,
Date Submitted: 5/24/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3190504
Who needs a d Central Office
copy?* F Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]