SAW-2021-02686_permitverification1 completion form.pdf

Action ID Number: SAW-2021-02686 County: Davie County
Permittee: Amy Euliss
NCDOT Division 9
Project Name: NCDOT/Sheek Street/Div 9
Date Verification Issued: January 25, 2022
Project Manager: Andrew Williams
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: Andrew Williams
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.
Signat0re of Permittee
June 30, 2022
Date