SAW-2019-00809 (signed NWP) 404 Pitzer completion form.pdf

Action ID Number: SAW-2019-00809 County: Stokes
Permittee: North Carolina Department of Transportation, Division 9, Amy Euliss
Project Name: Bridge No. 840105 Replacement
Date Verification Issued: 6/10/2019
Project Manager: Bryan Roden -Reynolds
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: Bryan Roden -Reynolds
Charlotte Regulatory Office
U.S Army Corps of Engineers
8430 University Executive Park Drive, Suite 615
Charlotte, North Carolina 28262
or
[e-mail]
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.
September 9, 2023
Signature of Permittee Date