20150537 Ver 1_CofC attachments_20201106 (2)

Action ID Number: County:

Permittee:

Project Name:

Date Verification Issued:

Project Manager:

Upon completion of the activity authorized by this permit and any mitigation required by
the permit, sign this certification and return it to the following address:

US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn:
_FIELD_OFFICE_

Please note that your permitted activity is subject to a compliance inspection by a U. S.
Army Corps of Engineers representative. Failure to comply with any terms or conditions
of this authorization may result in the Corps suspending, modifying or revoking the
authorization and/or issuing a Class I administrative penalty, or initiating other
appropriate legal action.

I hereby certify that the work authorized by the above referenced permit has been
completed in accordance with the terms and condition of the said permit, and required
mitigation was completed in accordance with the permit conditions.

_______________________________________ ______________________
Signature of Permittee Date