20190749 Ver 2_Brown Road permit completion form USACE_20201112

Action ID Number: SAW-2019-01013 County: Stokes County
Permittee: Amy Euliss
NCDOT Division 9
Project Name: NCDOT 17BP.9.C.12 SR 1128 Brown Rd Danbury Creek Br 290 Stokes Div9
Date Verification Issued: June 10, 2020
Project Manager: Eric Alsmeyer
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: Eric Alsmeyer
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest,NC 27587
919.554.4884,Ext. 23
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.
40 �U; s- November 12, 2020
Signs re of Permittee Date