20150313 Ver 1_Certification of Completion_20150730

JUL-30-2015 10:07 AM ROBERT ELLIOTT 704 896 9751 P.01
FT
D ProJect No, County:
Project Name:
0.4te of Issuance of 401 Water Quality
on
Titipon completion of all work approved within the 401 Water Quality Certification and 13tiffer Rules,
and any subsequent modifications, the applicant is reqWTed to return filis certificate to the
401 [Wetlands Unit, North Carolina Division of Water Resources, 1617 Mail Service Celater
Raleigh-, NC, 27699-1650. This form may be reMmed to DVVRby the applicant, the applic;�t's
2-uthorized agent, or the project engineer, It is not necessary to send certificates from all of these.
Agent's Certification
Date: v;'--e-,z It -7-49
L hereby state that, to -ale best of my abilities, due =e and
dihience was used in the observation • the c6tistruetion such tV,7.t.*,- cnitqvtighm
1 111 i I I k I INIUM
171nmm - =6301
'AL gdagt�41m
IT"411U.& logggagol'i nout
Signature: Date:
M71 I
Signature: Registration No.: Date: