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Me <br /> L <br /> el <br /> u r s 4. ,`�" �- d. fig, R x ,t sw 7 r s r H <br /> lee,` ' "7Ye.-7.¢ r`T"aleel <br /> ., el <br /> ell <br /> u.•5� el <br /> ,el jr .z ' Y" ' $ .�e�, .`�' }� . ra'e . d; y' � ' - , : ,. i# aie- <br /> IN <br /> ! <br /> el <br /> ei <br /> SELF-CERTIFICATION STATEMENT OF COMPLIANCE <br /> Permit Number: NW- 7913 <br /> Application Number : SAX2006-01903 <br /> Permittee ' s Name & Address (please print or type) : <br /> ell <br /> Telephone Number: <br /> Location of the Work : <br /> Date Work Started : Date Work Completed : <br /> Description of the Work (e . g., bank stabilization, residential or commercial filling, docks, dredging, <br /> etc .) • <br /> Acreage or Square Feet of Impacts to Waters of the United States : <br /> Describe Mitigation completed (if applicable) : <br /> Describe any Deviations from Permit (attach drawing(s) depicting the deviations) : <br /> lee <br /> * * * * * * * * * * * * * * * * * * * * <br /> I certify that all work, and mitigation (if applicable) was done in accordance with the limitations and <br /> conditions as described in the permit. Any deviations as described above are depicted on the attached <br /> drawing(s) . <br /> Signature of Permittee <br /> Date <br /> Mail this completed form to the U. S . Army Corps of Engineers, Regulatory Division, Special Projects & <br /> µ. Enforcement Section, Post Office Box 4970, Jacksonville, Florida 32232-0019 . <br /> ell <br /> el <br /> 71 <br /> ell <br />