HomeMy WebLinkAbout40758_NC DOT_20050303_
CAMA / LJ DREDGE & FILL
GENERAL PERMIT Previ6us permit #
❑New + f (Modification ❑Com fete Reissue Partial Reissue dV
P Date previous mit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name !`v
Address
City
State ZIP
Phone # ( )
Fax # ( )
Authorized Agent
Affected `l CW ❑ EW
::j PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF
I IH 1-1 UBA i N/A
❑ PWS:
❑ FC:
ORW: yes / no PNA
yes / no Crit. Hab. yes / no
Type of Project/ Activity
Pier (dock) length
Platform(s)
Finger piers)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAM not sure yes (no�
Sandbags: not sure yes no
Moratorium: n/a yes no
Photos: yes no.
Waiver Attached: yes no
A building permit may be required by:
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature Please read compliance statement on back of permit
Application Fee(s) Check #
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision - r . , `v`
City ZIP
Phone # (_ ) _ River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body r ri
(Scale: )
See note on back regarding River Basin rules.
Permit Officer's Signature
/ter,
Issui6gbate Expiration a
4 /=,v
Local PlanningJurisdiction Rover File Name
Statement of Compliance and Consistency `
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s) .
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certifythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
_ Tar- Pamlico River Basin Buffer Rules Other:
XNeuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-648 I) or the Wilmington
Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules.
Division of Coastal Management Offices
Central Office Elizabeth City District
Mailing Address: 1367 U.S. 17 South
1638 Mail Service Center Elizabeth City, NC 27909
Raleigh, NC 27699-1638 252-264-3901
Location:
Parker -Lincoln Building
2728 Capital Blvd.
Raleigh, NC 27604
919-733-2293 / 1-888ARCOAST
Fax: 919-733-1495
Fax: 252-264-3723
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Morehead City District
151-B Hwy. 24
Hestron Plaza II
Morehead City, NC 28557
202-808-2808
Fax: 252-247-3330
(Serves: Carteret, Craven, Onslow -above
New River Inlet- and Pamlico Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax: 252-948-0478
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-395-3900
Fax: 910-350-2004
(Serves: Brunswick, New Hanover,
Onslow -below New River Inlet- and
Pender Counties)
www.nccoastalmanagement.net
Revised 10/05/01
XCAMA/`�ZIJREDGE & FILL
1V? 40758-4
GENERAL PERMIT
�lNew , lModification ''Complete Reissue
Previous permit # A11,4
—Partial Reissue Date previous permit is ed
As authorized by the State of North Carolina, Department of Environment and Natural Resources ,(
0 3 OC3
and the Coastal Resources Commission in an area of environmental
concern pursuant to I SA NCAC 7# - Z
,- Rules attached.
Applicant Name N� C D O j
Project Location: County n
Address PC 8cK %
Street Address/ State Road/ Lot #(s) l3 Z G f
Cary �r^2�.Vlb! I State J11� ZIP
`
`i -/3 �7 4 1 cress� c;- t j EC 5v,Oczd (7rPeK'_
Phone # (Z�Za�,3G �{q(� Fax # ( )
Subdivision � Q�2,Y, D . Y c z /
Authorized Agent �� JG��LS
City-- /�C��cc ZIP S t
Affected �c SEW ElPTA XES [IPTS
Phone # ( ) River Basin 'n eLt n
IH ❑ UBA ❑ N/A
s ElOEA ElHHF El AEC:
'. r
AdI Wtr. Body 0cx
ennd- a man unkn
PWS: FC:
El❑
ORW: yes /� PNA yes o Crit. Hab.
yes / no Closest Maj. Wtr. Body % Lus--� K -
Type of Project/ Activity
G ct t_-Y v- R �� �c<ce- ilte
(Scale: b✓1-- t�rrEzcai
Pier (dock) length
_
i
-
Platform(s)!
Finger pier(s)
Q i
Groin length�-
number-
Bulkhead/ra
PPgt Ri length
avgdistance offshore
t
I
416-
max distance offshore
Basin, channel
cubic yards
Boat ramp
I
Boathouse/ Boatlift
Beach Bulldozing
- -'-+{-
--- -.
Other(nd• 4
Shoreline Length
- -
-
SAV: not sure yes
Sandbags: not sure yes
-
I
Moratorium: n/a es no
_j-
-
Photos: yes
- -- -
-- --- -- - -
Waiver Attached: no
A building permit may be required by: YI�LlAl
KSele note on back regarding River Basin rules.
Notes/ Special Conditions �, i ii r1 L)-e,-
^/
/ "l �2 JZ//p
�0 r®.tyr�
� '{2�vULP.�1
ay 166 e)A,
Agent or Applicant Printed Name
Signature "Please read compliance statement on back of permit"
/0060c&b,)� U OS mil. Q1, 2.2cam((
Application Fee(s) Check #
Permit Uf icer's Jignaturk /
\l 3 z
Issu- g Dat6 E iration Date
Lo al Plannin ris action Rover File Name
Debit to DOT
Subject: Debit to DOT
Date: Thu, 03 Mar 2005 06:00:42 -0500
From: Bill Arrington <Bill.Arrington@ncmail.net>
To: Jaye Poole <Jaye.PooleCc) ncmail.net>
CC: Shery Keel <Shery.KeelC ncmail.net>
Good morning Jaye,
I hope all is well.
Codld you debit Dot for $100.00 for GP 40758-C, WBS Element No.
2.20691, Culvert replacement at crossing of UT to Broad Creek on SR
1320,'approximately 0.4 miles east of SR 1321.
Thanks,
Bill
W�f Z-P(Y
1 of 1 3/3/05 8:09 AM
V
For DCM-MP-S
f; ��
u� Eb
;
U"ULVERTS
$100.00 Processing Fee
NCDOT WBS NO. 2.206911
Attach this form to Joint Application for CAMA Major
Permit, Form DCM-MP-1. Be sure to complete all other
sections of the Joint Application that relate to this
proposed project.
1. BRIDGES N/A
a. Public Private
b. Type of bridge (construction material)
c. Water body to be crossed by bridge
d. Water depth at the proposed crossing at MLW or
NWL
e. Will proposed bridge replace an existing bridge?
_ _Yes No
If yes,
(1) Length of existing bridge
(2) Width of existing bridge
(3) Navigation clearance underneath existing
bridge
(4) Will all, or a part of, the existing bridge be
removed? (Explain).
f. Will proposed bridge replace an existing culvert(s)?
Yes No
If yes,
(1) Length of existing culvert
(2) Width of existing culvert
(3) Height of the top of the existing culvert above
the MHW or NWL
(4) Will all, or a part of, the existing culvert be
removed? (Explain)
g. Length of proposed bridge
h. Width of proposed bridge
i. Height of proposed bridge above wetlands
j. Will the proposed bridge affect existing water flow?
_ _Yes No
If yes, explain
k. Navigation clearance underneath proposed bridge
1. Will the proposed bridge affect navigation by
reducing or increasing the existing navigable
opening? Yes _ No
If yes, explain
m. Will the proposed bridge cross wetlands containing
no navigable waters? Yes No
If yes, explain
n. Have you contacted the U.S. Coast Guard concerning
their approval?
Yes No
If yes, please provide record of their action.
2. CULVERTS
a. Water body in which culvert is to be placed
Tributary flowing into Broad Creek
b. Number of culverts proposed 1
c. Type of culvert (construction material, style)
CORRUGATED METAL PIPE
d. Will proposed culvert replace an existing bridge?
Yes _ _X No
If yes,
(1) Length of existing bridge N/A
(2) Width of existing bridge N/A
(3) Navigation clearance underneath existing
bridge N/A
Revised 03/95
form DCM-NIP-5
(4) Will all, or a part of, the existing bridge be
removed? (Explain)
e. Will proposed culvert replace an existing culvert?
_ X Yes — _No
If yes,
(1) Length of existing culvert 32'
(2) Width of existing culvert 18"
(3) Height of the top of the existing culvert above
the MHW or NWL 0.5'
(4) Will all, or a part of, the existing culvert be
removed? (Explain) YES
f. Length of proposed culvert 45'
g. Width of proposed culvert 36"
h. Height of the top of the proposed culvert above the
MHW or NWL IS
Will the proposed culvert affect existing water flow?
Yes X _No
If yes, explain
j. Will the proposed culvert affect existing navigation
potential? Yes X No
If yes, explain
3. EXCAVATION AND FILL
a. Will the placement of the proposed bridge or culvert
require any excavation below the MHW or NWL?
X _ _Yes No
If yes,
(1) Length of area to be excavated 51'
(2) Width of area to be excavated 8'
(3) Depth of area to be excavated 2'
(4) Amount of material to be excavated in cubic
yards 408 SQUARE FEET
b. Will the placement of the proposed bridge or culvert
require any excavation within:
X
Coastal Wetlands SAVs
Wetlands
_Other
If yes,
(1)
Length of area to be excavated 7.55'
(2)
Width of area to be excavated 7.55'
(3)
Approximate area to be excavated
57Ft2
c. Will the placement of the proposed bridge or culvert
require any high ground excavation? X Yes
No
If yes,
(1) Length of area to be excavated 32'
(2) Width of area to be excavated 5.5'
(3) Amount of material to be excavated in cubic
yards 176 SQUARE FEET
d. If the placement of the bridge or culvert involves any
excavation, please complete the following:
(1) Location of the spoil disposal area
Temporary spoil area is existing road bed
(2) Dimensions of spoil disposal area
20' x 20'
(3) Do you claim title to the disposai area?
X Yes No
If no, attach a letter granting pernission from
the owner.
(4) Will the disposal area be available for future
maintenance? X Yes No
(5) Does the disposal area include any coastal
wetlands (marsh), SAVs, or other wetlands?
Yes X No
If yes, give dimensions if different from (2)
above.
(6) Does the disposal area include any area below
the MHW or NWL? Yes X No
If yes, give dimension if different from No. 2
above.
Will the placement of the proposed bridge or culvert
result in any fill (other than excavated material
described in Item d. above) to be placed below MHW
or NWL? X Yes _ No Open Water Impacts
If yes,
(1) Length of area to be filled 7.14'
(2) Width of area to be filled 7.14'
(3) Purpose of fill For Pipe Bedding and
Cover
f. Will the placement of the proposed bridge or culvert
result in any fill (other than excavated material
described in Item d. above) to be placed within: N/A
Coastal Wetlands SAVs Other
Wetlands If yes,
(1) Length of area to be filled _
(2) Width of area to be filled
(3) Purpose of fill
g. Will the placement of the proposed bridge or culvert
result in any fill (other than excavated material
Revised 03/95
Form DCM-MP-5
described in Item d. above) to be placed on signature
high) ound? _Yes X No Date 01/23/05
If yes,
(1) Length of area to be filled
(2) Width of area to be filled
(3) Purpose of fill
4. GENERAL
a. Will the proposed project involve any mitigation?
_ Yes No X
If yes, explain in detail
b. Will the proposed project require the relocation of
any existing utility lines? Yes X No
If yes, explain in detail
c. Will the proposed project require the construction of
any temporary detour structures?
Yes X No
If yes, explain in detail
d. Will the proposed project require any work channels?
Yes X No
If yes, complete Form DCM-IMP-2
e. How will excavated or fill material be kept on site
and erosion controlled? Silt fence
f. What type of construction equipment will be used
(for example, dragline, backhoe or hydraulic dredge)?
Tvpical Bridge construction equipment
g. Will wetlands be crossed in transporting equipment to
project site? Yes X No
If yes, explain steps that will be taken to lessen
environmental impacts.
h. Will the placement of the proposed bridge or culvert
require any shoreline stabilization?
_ Yes X No
If yes, explain in detail
NCDOT-Pamlico County Pipe Replacement on Sr
1320
Applicant or Project Name
Revised 03/95
}yrv�
Y
E
� t
r• Fir
�.:.}':;:II F��rI,. 9t q�+u'ijj:',�+:Pj�u :'4:�'1,'•:".:.���" :
i=!' {ter, `fit i•r� .,
Ell
Mig
•
:
H
z
U
�I
w
F�
Ir )
9
STATE OF NORTH CAROLDTA
DIVISION OF ffiGHWAYS
VICINITY Ie' AI?
—
�,,:E ATTACHED SHEET
LUCASR..-132U.-PFi.M.LICO ROAD
EXISTING 32'xl8" RCP_ PROP0SED
_45'x36" CMP
PIPE 9.Vl L,&(jl;HVjjj' _PAMLICO_
COUNTY
T7FE GF IF? 0pjT-------------------------------------------
CAMA GENERAL PERMIT APPLICATION
----------------------------------------
rr 9�RLr r.n -f -Fi U•
2G'/r Il C=NfALXC Z.'74...,.. rcirFFgF,-E.R
r
PAW.
• JAYV
'
Er�.p �•�
--
I pn!rrnt,�C M3 Qie
uE/!P' �f r
---
AREA ! AREA 2
EfyK zgggrJp7.
•— _- ErTM O.p
- _7 - - - - - - - -_—rp ib Fr p _ _ -
- - - - - - - - - - � •- _
4.ara•
s'^•"'r "0'0
'+® /2 uilES row
SR /J/T
_v _3 - - - _ _ _ _ _. _ _ - - _ r0 PAVU- -�1►
-
_ _ _ _ _ - _ - .-. _ _ _ _ _ _ -
- _ _ - _ -
EXISTING SP • """'"c .Erry mwK..R,i
aJASrnj. iu,ss tr
ARCA 4 NXA J eirsn a rtn. `a' •' i?' +i+•
1
WOODS
�C uC Orr
/
I.CN-
It(JUr I.QNIT •v 9qn o- � ,mCnh vss
KAW'Sr KUC 38N3 ' ACE LAW COW"
&Dvkw am
GRAPHIC SCALES
PROFILE (HORIZONTAIJ
DESIGN DATA
ADT -- ------
ADT -- -- --- --
DHV - %
D -- %
T %
V - -- MPH
• TTST --% DUAL
PROJECT LENGTH
JWAM W 7= (UM @ i
DIVISION OF HIGHWAYS
ansum=
mil' Cr VAT AA7&
-- I.iIIT9 ANS
ffimm m
AMWAY M W(
911
MY (W IMM IMi\A
DWAA"Mr OF nUMM RrAUW
WE= MWWAP AOII(AQS7 na
11 16'x3' DITCH
� rl
jJ SHIRLEY TINGLE 2p, gyp, I 20,
SR 1320 P.O. BOX 397 ear ZpFFF�
PAMLICO COUNTY ORIENTAL NC 28515
PIPE REPLACEMENT l2 CMP1 Zow, N�
EXISTING 32'xl8' RCP
PROPOSED 45x36' CUP l�
Q41
EXISTING R/W ��r ' IQ' RCP
j AREA /
EXISTING SHoliLDER POINT
_ - _ - - - - - / - - EXIST/NG D/TCH
- - - - - - - - - - - - - - - - - EXISTING E -
- - - - - - - - - - - - - - - 2 SO FT AN
COASTAL WETLAND IMPACT
- - - - - - - - -
0.4 MILES
��— TO SR 132/,
STRAITS ROAD
------ EXlsrlIIGEP�--...- ------------------
EXISTING SP ^4
WOODSTD
AREA 4
COASTAL IMAPCTS
AREA I= 2 SOUARE FEET
OF COASTAL WETLAND IMPACTS
AREA 2 = ISOUARE FOOT
OF COASTAL WETLAND IMPACTS
AREAS J V 4 - 54 SOUARE FEET
OF COASTAL WETLAND IMPACTS
AREAS I & 2 = 51 SO FT
OPEN WATER IMPACT
�G\
WILLIAM P.GRANT
112 INLET COURT
HAMPSTEAD,NC 28443
4'x2' DITCH
F
WILLIAM TINGLE 2p.
P.O. BOX 397
ORIENTAL NC 28515 B�F
2p,�,�Fip
z
AREA 2
EXISTING
5/S0 FT OPEN WATER IMPACT
- ISO FT COASTAL WETLAND IMPACT
E- - - - - - - - - - - - - - - - - -
EXISTING JZxl8'RCp
PROPOSED 45'x3ECUP 1.2 MILES TO _
SR 1317
AMLICO
-------------- --TO P-----------
--------54 SDUARE FEET OF COASTAL IMPACTS
AREA 3 {
EXISTING
1pA,� F,p
z WOODS
NOTE: THIS DITCH IS A
BLUE ONE STREAM
AS SHOWN ON THE ORIENTAL USGS
OUAD MAP
BATE LAND COMPANY
3405 TRENT ROAD
NEW BERN, NC 28562
C T N 0 . 2.2069/I
January 28.2005
SR 1320 CULVERT C OSS3M
lv PAY IC0 PAMLICO COUNTY
PIPE REPLACEMENT
EXISTING RCP
PROPOSED 4S'x3,G" CMP
ROAD EXISTING 321xlB" RCP
SR 1320 5.5
xA 2 rY
AMA TO BE E=YATEO
AND DACMLLED
LO' I « 1.5'
o � na i�- NOT TO SCALe
PROPOSED 45'x36" Cif P
8` -
AREA TO BE EXCAVATED
AND BACKFILLED
UlDERCII T i
BACXFILL
EXCAVATION ABOVE NWL:
5.5'w x 381 x 25'd = 209 SQUARE FEET
EXCAVATION BELOW NWL
8'w x 5/'L x 2.0'd = 408 SQUARE FEET
eucrn 12' —o
— !iWL
PROPCSED RIP RaP @ END
OF PIPE
�2� /�
C�
l2" NfGVI aUN 2EDD!NG
c
z
Li
z
W
W
c
W
p
J
W
W O
NOT TO SCALE
PROPO ED RIP RaP D END
v
c TOP IE`ti v
p
Z_
O
z
O
LIO
N
W
W
X
7
(J X
O W
W
W
rI
WIC I
PRCPJSEO PIPE ✓� PITCH
fDlH
FINISHED EARTH SLOPE AS REQUIRED
PROPOSED RIP RAP 0 END
OF PIPE
■ Complete items 1, 2, and 3. Also complete
i item 4 if Restricted Delivery is desired. -
■ Print your name and address on the revere
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
A. Sign tur v� /
��Jj ❑Agent
X
❑ Addressee -
B. Received by (Printed Name) C. D 1e of elivery
' i;
D. Is delivery address different from Item ? ❑ es
If YES, enter delivery address below: ❑ No
t t C, � 95 � 3. Se ice Type
�V rtified Mail ❑Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2 Article Number 7003 1010 0002 6560 5316
(IYansfer from service label)
1 PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540
UNITED STATES POSTAL SERVICE First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
NCDOT, DIVISION OF HIGHWAYS
ATTN: JAY JOHNSON
P. O. BOX 1587
GREENVILLE, NC 27835-1587
13;-0, P
L i1f�i11ti3iftttiSiit?4�21:ii? {tl: ii111fIiSil!'.SIIIIEi�lIII
{
r
S ■ Complete items 1, 2, and 3. Also complete
f item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
i 1. Article Addressed to:
A.
X
a
I
_ j
I
Agent
B. Received by (Printed Name) 1O.Pee, Delivery
Kosw.RaZ
-,
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Se ice Type
Certified Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Article Number
(Transfer from service label) 7003 1010 0002 6560 5509
5 PS Form 3811, February 2004 Domestic Return Receipt 1 o2sss-o2-M-t e4o
UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
NCDOT, DIVISION OF HIGHWAYS
ATTN: JAY`1OHNSON
P. O. BOX `f87
GREENVILLE, NC 27835-I587
13 .�_o _ f la—"
[:si:(�ti i��iil4 FS34�?if%Ii??Sili�?1?�'.SIt�?iS t3S?1:�?3i��lii ii
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
I ■ Attach this card to the back of the mailpiece,
or on the front if space permits.
} 1. Article Addressed to:
_ n►e-E- C�UA --
A. Signature
B. Received (Printed Name) c.
Addressee
D. Is delivery address different from item 1? O Yes
If YES, enter delivery address below: ❑ No
3. Service yg
erti c ❑ Ex ss all
O Re
giste 'LJ, ., etur eceipt for Merchandise
❑ Insured
4. Restricted Delivery? (Extra Fee) p Yes
2. Article Number
(transfer from service IabelJ 7 0 0 3 1010 0002 6560 5323
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1W
UNITED STATES POSTAL SERVICE First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
NCDOT, DIVISION OF HIGHWAYS
ATTN: JAY JOHNSON
P. O. BOX 1587
GREENVILLE, NC 27835-1587
i �[1E�E��!l3��lS�lS!!�SlifiStlflllit�l�lti4�t!!��lI�E�ltil�ltti�
■ Complete items 1, 2, and 3. Also complete A. Signature
item 4 if Restricted Delivery is desired. 1 .13 Agent
■ Print your name and address on the reverse X CL �� ' 17 Addressee
so that we Can return the card to you. B. Received by (Printed Name) C. Da a"of D livery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different from Rem 1? ❑ s
1. Article Addressed to: If YES, enter delivery address below: ❑ No
i5..%wti.Ae.�� �'►e.
3. S Ice Type
►\,1J/11V�► ified Mail ❑Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2: Article Number
(Thansler from service label) 7 0 0 3 1010 0002 6560 5330
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 ;
R_ ,
UNITL.D STATES POSTAL SERVICE First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
NCDOT, DIVISION OF HIGHWAYS
ATTN: JAY JOHNSON
P. O. BOX 1587
GREENVILLE, NC 27835-1587
L i!!1!ii!lill!!i!'.fil?SISI!S?i3�i1!�!I!Sfi1S'.?il!llf4?!fFl?t?!�