20180118 Ver 1_CofC attachments_20221229

Action ID Number: SAW-2018-00201 County: Perquimans County

Permittee: Clay Willis, NC Department of Transportation

Project Name: NCDOT B5604 Perquimans Bridge 19

Date Verification Issued: February 20, 2018

Project Manager: Kyle Barnes

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: Kyle Barnes

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

12/29/2022