20140675 Ver 1_Certification of Completion_20151130

N ENR
North Carolina Department of Environment and Natural Resources
Divisior of'Nlater Resources
Pat',f9cCrory Jonn G. Skvarla, ill
Governor Secretary
DWR Project No: 14 -667 -6 -County: y.11 � it-,-;
Applicant: e �.QcFc- t-� 2srt,rki.�
Project Name: Cav, �'c:r a C
401 Water Quality Certification Issued Date: L, Zc�i 4
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the DWR
401 & Buffer Permitting Unit, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form may be
returned to DWR by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Certification
I, J 'I? I—\ iY r— a -I tz hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and oth supporting materials.
Signature: ., - L `f Date: t q mac%

Pamlico C.Pourty Buo"Ming Department
The Cortific:ate of Completion is p:o-of that a structure or system is complete for certalti types of pernIts 1; €elease d for
use and may be connected to a utility systari. 'This certificate does nct grant authority to occupy or conrn_ct a bul Id#ng,
such as a shell budEding, prior to the irss aance of the ce rtificate of o,ccuFancy
Perrnk Type, __i C;a!ac:e
I)ste Issued: August C6, 2015 District:
Parcel plumb IOf-36-52
permission Is herby chanted to _`—,—_
io use the Kructure located at:
50 Windy Court
Oriental IAC 28571-9115
dot Transferable
Bldg. Permit :Vo: GAR -3-15.9.21
Townsh+p2
Jack. & Carol Herman
7
7a
I