20161105 Ver 1_404 Completion Form_20180501

Action �D Nurnber; SAW-2016-02282 County: Davidsau
Permittee: NC DOT Div 9
Amy Euliss
Pro�ect Nanne: NC DOt Br 95 SR 1838 Div 9 D�vidson Co,
Date Veriiicatio�i Issued: November 17, 2016
Pro�jec# Manager: John Thomas
Upan completion of the activity authorized by #his permit and any initigation required by �he permit,
sign this certif�cation and return it to the folloFving address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Aitn: John Thomas
Raleigh Regulatory Fie1d Office, SuiYe 105
3331 Heritage Trade Drive
Wake Forest, NC 27587
Please note that your �ermitted activity is subject to a connpliance inspeciion by a U. S. Artr�y Corps of
E�gineers representative, Failure to comply with any terms or conditions of this autharizatio� tnay
result ia the Corps suspending, modifying or revoking the authorization and/or issuing a Class Y
administra�ive penalty, or initiating other appro�riate legal action.
I hereby certify fhat the �vork authorized by the above referenced �ermit has bee� co�pleted in
accordance with the terms and condition of the saitl �ermit, and requ'rred mitigation was completed in
accordance with the permit conditeons.
/�vn �� April 30, 2018
Signafure of Permitfee Date