MARYLAND STATE HIGHWAY ADMINISTRATION
	PS&E CERTIFICATION OF ENVIRONMENTAL PERMITS
FOR LOCAL GOVERNMENT PROJECTS

F.A.P. No.:__________________State No.:____________________Local No.:_______________

Project: _________________________________________________________________________

Permit/Approval	Applied	Anticipated	Received

Erosion & Sediment Control	   /   /   	   /   /   	   /   /   
Stormwater Management	   /   /   	   /   /   	   /   /   
404 or Nationwide Permit	   /   /   	   /   /   	   /   /   
US Coast Guard Permit	   /   /   	   /   /   	   /   /   
DNR Wetlands License	   /   /   	   /   /   	   /   /   
Other	   /   /   	   /   /   	   /   /   
Waterway Construction Permits	   /   /   	   /   /   	   /   /   

Ad Date: _____________ Bid Open:_____________ Award:_____________ NTP:_______________

[   ]	Environmental Permits are not required.

[   ]	All Environmental Permits have been received as noted above.

[   ]	All Environmental Permits are expected to be received before the scheduled bid opening

[   ]	All Environmental Permits are not expected to be received before notice to proceed.  However,          County intends to issue a "Limited Notice to Proceed."  The attached letter to FHWA must be included with the PS&E submission to FHWA.

	Prepared by:	________________________	
				
	Phone:	________________________	
				
	Certified by:	________________________