20161210 Ver 1_404 Completion Form_20180430

Action ID Ne�mber: SAW-2016-02433 County: Rawan
Permittee:
Projec� Nanie:
NCDOTDiv9
Amy Euliss
NC DOT br 353 SR 1349 cui�ert Div 9 Rown Co.
Date Veriticaiion Issued: December 14, 2016
Project Manager: Jahn Thomas
Upan campletion af the activiiy au#horized by this �ermit and any mitigation required by the permit,
sign this certi�cation and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: John Thomas
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, S�ite 105
Wake Foresf, NC 27587
Please note tha� your permitted activity is subject to a compliance insnection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms ar ca�ditions of this authorizatian may
resu�t in the Corps suspending, modifying or re�oking the authoriza�ion and/or issuir�g a Class I
administrative penalty, 4r initiating other appropriate legal action.
I hereby certify that the �vork authorized by fhe above referenced permit has becn completed in
accordance �vith the terms and condition of the said permit, and required rnitigation was campleted in
accordance with the permit conditions.
�✓T�y ���
Signature of Permittee
April 30, 2018
Date