20151074 Ver 2_W-5313 404 permit completion form_20201215

Action ID Number: SAW-2012-00693 County: Rowan
Permittee: North Carolina Department of Transportation
Project Name: NCDOT SR 1221 Beatty Ford Road Rowan Co. Div. 9
Date Verification Issued: May 4, 2017
Project Manager: James Lastinger
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
Raleigh Regulatory Field Office
Attn: James Lastinger, Regulatory Project Manager
3331 Heritage Trade Dr., suite 105
Wake Forest, NC 27587
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.
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