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57176_GANEY, TATE_20110328
❑ CAMA / ❑ DREDGE & FILL GENERAL PERMIT Previous permit # ONew ❑Modif--ation ❑Complete Reissue ❑Partial Reissue Date previous permit 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 El Rules attached. Applicant Name_ Project Location: County Address City Phone # ( )_ Authorized Agent Affected ❑ CW AEC(s): ❑ OEA ❑ PWS: ORW: yes / no — State_ Fax # ( ❑ EW ❑ PTA ❑ HHF ❑ IH ❑ FC: - PNA yes / cc ❑ ES ❑ PTS ❑ UBA ❑ N/A Crit.Hab. yes / no Street Address/ State Road/ Lot #(s) 3Ut i' E (� i Subdivision 't c f 1"c r A'! City ?tom: ZIP t' Phone # _71— MA River Basin N Q k f rC S Adj. Wtr. Body _7.r eG C r Jet t (nat /man /unkn) Closest Maj. Wtr. Body +�� I � Type of Project;/ -,Activity s Pier (dock) length x • ■■■■.■■■■■■■■01■ (Scale: i SlE■■■■■■■■■■■■■■■■■��EES M. ■ ■ME MEMEMME MEMNON IMUWU ■■■■■■■�s�ela■■■■n■■■ ■e■■■■■■■■■■■■■■e■■■� e■■■ili■■■■e■M:.Er■�1f ■■■■e■■■e■■■■ J■■■ ■■�� ■■■c■���■e■■e� e■■■■■■■■■erg■■■■■■■ ■�■iiiM. e�■■i■■�i�i■i■iii i■■�■i■iiii■iiiiii■■■i ■■■■■■1■■■■■�/E�l■■■■■■■■■■■.■■■■■■■■■■■■■ ■ ■■PRie■■LU■M■E�■■ee■■i,rra ��i��N■e■■■■�■■■ ■�■C'i■■■■ ■Lei■■■■■■■'Fa■■�■..■e■■■■■■■■ ■■■■■■i■■■■■■MMI■■ ■E��ll��!■■ .!•■��■■■■■■■itr■e■■■■■■■■■e■■■■e■■■■■■■■ eifjfililL'LnN■■■E.■Il■e■■■■ MEN �.■�����n�!�■�!■�I■�e�■fie■■■ ■■■■■■1�i1�:9iAl�■■■■■■■■■ or Applicant Printed Name Signature ** Please read compliance statement on back of permit ** Permit Officer's -Signature ! o 1_ Issuing Date Expiration Date Application Fee(s) Check # Local Planning Jurisdiction 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, certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: ❑ Tar- Pamlico River Basin Buffer Rules ❑ Other: ❑ Neuse 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 (252-946-6481) or the Wilmington Regional Office (910-796-7215) for more information on how to comply with these buffer rules. Division of Coastal Management Offices Raleigh Office Mailing Address: 1638 Mail Service Center Raleigh, NC 27699-1638 Location: 2728 Capital Blvd. Raleigh, NC 27604 919-733-2293 Fax:919-733-1495 Morehead City Headquarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ 1-888ARCOAST Fax: 252-247-3330 (Serves: Carteret, Craven, Onslow -above New River Inlet- and Pamlico Counties) Elizabeth City District 1367 U.S. 17 South Elizabeth City, NC 27909 252-264-3901 Fax: 252-264-3723 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans 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 910-796-7215 Fax: 910-395-3964 (Serves: Brunswick, New Hanover, Onslow -below New River Inlet- and Pender Counties) Revised 08/09/06 WA 'Ar4i � NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue James H. Gregson Dee Freeman Governor Director Secretary BUFFER AUTHORIZATION CERTIFICATE FOR PIER AND DOCKING FACILITIES ACCESS WAY A riparian buffer authorization is required for pier and docking facilities access ways through the Tar -Pamlico & Neuse River Riparian buffer per Division of Water Quality (DWQ) regulations 15A NCAC 02B.0233 & .0259. The Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water Quality (DWQ) has reviewed your project proposal, determined that the project as proposed complies with the aforementioned regulations, and made a "no practical alternatives" determination per those regulations. Those activities covered by your Coasta! Area Managemert Act (CA%!A) permit have roceivcd Buffer Authorization as long as the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to comply with this Buffer Authorization shall subject the property owner & the party (contractor) performing the construction Wor land clearing to a civil penalty of up to $25,000 per day per violation. 1. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer perpendicularly (which is defined as between 75 and 105 degrees) unless otherwise approved by DCM. The alignment shall minimize the removal of woody vegetation to the greatest extent practicable. 2. Pervious Materials: All reasonable measures shall be taken to ensure the access way is made of pervious materials like open -slatted wood or composite, mulch, or grass to meet the intent of the rules to the maximum extent practicable. 3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet. 4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your property indicating the relative location of the pier or docking facility and any requested access way. This drawing will be used to aid in compliance and monitoring efforts. By your signature below you agree to be held responsible for meeting all of the conditions listed above and verify that all information provided is complete and accurate. _FtV',0__<�CA Q� gen - r Applicant Printed Name E). gen r Applicant Signature CAMA GENERAL PERMIT #: 57) 7 6 C Washington Office Morehead City Office 943 Washington Square Mail 400 Commerce Avenue Washington, NC 27889 Morehead City, NC 28557 Phone 252-946-6481 Phone 252-808-2808 r� Permit O cer's Signature 2� r Issue D to An Equal Opportunity/Affirmative Acton Employer — 50% Recycled/10% Post Consumer Paper Version 5, 09/2009 A4J NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue James H. Gregson Dee Freeman Governor Director Secretary BUFFER AUTHORIZATION CERTIFICATE FOR PIER AND DOCKING FACILITIES ACCESS WAY A riparian buffer authorization is required for pier and docking facilities access ways through the Tar -Pamlico & Neuse River Riparian buffer per Division of Water Quality (DWQ) regulations 15A NCAC 02B.0233 & .0259. The Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water Quality (DWQ) has reviewed your project proposal, determined that the project as proposed complies with the aforementioned regulations, and made a "no practical alternatives" determination per those regulations. Those activities covered by %,our Coastal Area Management Art (CA,NIA) permit h ve reccivcd Buffer Authorization as long as the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to comply with this Buffer Authorization shall subject the property owner & the party (contractor) performing the construction &/or land clearing to a civil penalty of up to $25,000 per day per violation. 1. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer perpendicularly (which is defined as between 75 and 105 degrees) unless otherwise approved by DCM. The alignment shall minimize the removal of woody vegetation to the greatest extent practicable. 2. Pervious Materials: All reasonable measures shall be taken to ensure the access way is made of pervious materials like open -slatted wood or composite, mulch, or grass to meet the intent of the rules to the maximum extent practicable. 3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet. 4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your property indicating the relative location of the pier or docking facility and any requested access way. This drawing will be used to aid in compliance and monitoring efforts. By your signature below you agree to be held responsible for meeting all of the conditions listed above and verify that all information provided is complete and accurate. Applicant Printed Name or Applicant CAMA GENERAL PERMIT #: Washington Office 943 Washington Square Mall Washington, NC 27889 Phone 252-946-6481 Morehead City Office 400 Commerce Avenue Morehead City, NC 28557 Phone 252-808-2808 �J Permit Officer's Signature 3 z� Issue Date An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper Version 5, 09/2009 -., XCAMA / ❑ DREDGE & FILL GENERAL ' PERMIT Previous permit# I(New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit 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 9 2 Z t ® Rules attached. Applicant Name j �Af !!�iw )i ES ❑ PTS El UBA El N/A - - -El PWS: ❑ FC: nww• vP� / AnN PNA ves / Crit.Hab. yes / no Project Location: County_�—' - C- > , a , Street Address/ State Road/ Lot #(s) Subdivisions �� ..f�PC tA� - City ZIP Phone # () .� River Basin Adj. Wtr. Body I ;:, Gat /mom an /unkn) Closest Maj. Wtr. Body- 114 +©■�■■�■■■■■■■� NOON■■ ■ ■ ��■��� MINME ■■■�..�■■�■... ■�.1�. I■:: m■ll■�i■■■■i■iiii.�■i ' '.'i■■■■�r■■ ■■i■■■' ■Is ■■■ ■ ■■Is■!�■■■■■■ ■■■■■ ■NN■■■U�pMEN .. ■■■ ■&s C-e? NOON■■ ■■■��■■�■■�■ .. .1.■■■■■9■■■�■.... :.■�S■ ■■■ ■�I■■■�C''10■.■■■■■■■■■■■■■■■S ..... I■■■ .r.f!Is ..............■■....... In ME Is 0 �■ • ■■■■ ■I �i■■■■+ 9 NOON■ ■■■■■■■■ ■ ■ - ■■0 i.1 %■■■■■11' , MEN ■■■■■mom ■■■■■■I■O■■►w ■I■■■■■■■ mom ON ■■ ■ 1 ■ 1 NOON ■ ■■■■■■■■■■■■■■ • ■■�.�.■ ■ i .� ■� ■CI■.■■. C 1■..■■�.O■O■■■■■■Ocro ■■■■■■■■.■..■■.■. _ ■ ■ ■I ■■■■�� mom ME ■1 NOON■■■ ■NONE ■■■■■■■■■MEN _ Q r''�■■�!■■■■■■ •` ,'! ■ t! r ■No ■1 ■NOON■ ■■E OO■■OON Please read compliance statement on back of permit Application Fee(s) Issuin-dbatel Exbiradon Date Local PlanningJurisdiction Rover File Name NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary March 28, 2011 Bobby Cahoon Construction 6003 Neuse Rd. Grantsboro, NC 28529 Attached is General Permit 457176C to Replace a 222x5 pier, 30x9 platform, 20X5 platform and 6 mooring piles at 809 Osprey Court in New Bern, NC. Also, enclosed is two Buffer Authorization Certificates, please sign and print your name as indicated and return one in the enclosed, self-addressed envelope. In order to validate this permit, please sign the permit as indicated. Retain the white copy for your files and return the signed yellow and pink copies to us in the enclosed, self-addressed envelope. If the signed permit copies are not returned to this office before the initiation of development, you will be working without authorization and will be subject to a Notice of Violation and subsequent civil penalties. We appreciate your early attention to this matter. Sincerely, Barry Guthrie Coastal Management Representative lsb Enclosures 400 Commerce Avenue, Morehead City, North Carolina 28557 Phone: 252-808-2808 \ FAX: 252-247-3330 \ Internet: www.nccoastalmanagement.net An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post consumer Paper NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue James H. Gregson Dee Freeman Governor Director Secretary BUFFER AUTHORIZATION CERTIFICATE FOR PIER AND DOCKING FACILITIES ACCESS WAY A riparian buffer authorization is required for pier and docking facilities access ways through the Tar -Pamlico & Neuse River Riparian buffer per Division of Water Quality (DWQ) regulations 15A NCAC 02B.0233 & .0259. The Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water Quality (DWQ) has reviewed your project proposal, determined that the project as proposed complies with the aforementioned regulations, and made a "no practical alternatives" determination per those regulations. Those activities covered by your Coastal Area Management Act (CAMA) permit have received Buffer Authorization as long as the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to comply with this Buffer Authorization shall subject the property owner & the party (contractor) performing the construction Wor land clearing to a civil penalty of up to $25,000 per day per violation. 1. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer perpendicularly (which is defined as between 75 and 105 degrees) unless otherwise approved by DCM. The alignment shall minimize the removal of woody vegetation to the greatest extent practicable. 2. Pervious Materials: All reasonable measures shall be taken to ensure the access way is made of pervious materials like open -slatted wood or composite, mulch, or grass to meet the intent of the rules to the maximum extent practicable. a. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet. 4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your property indicating the relative location of the pier or docking facility and any requested access way. This drawing will be used to aid in compliance and monitoring efforts. By your signature below you agree to be held responsible for meeting all of the conditions listed above and verify that all information provided is complete and accurate. ge ,or Applicant Printed Name A(& or Applicant Signature �g, I L)) Permit Officer's Signature Issue Date CAMA GENERAL PERMIT #: � I76 C Washington Office 943 Washington Square Mall Washington, NC 27889 Phone 252-946-6481 Morehead City Office 400 Commerce Avenue Morehead City, NC 28557 Phone 252-808-2808 Version 5, 09/2009 An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue James H. Gregson Dee Freeman Governor Director Secretary BUFFER AUTHORIZATION CERTIFICATE FOR PIER AND DOCKING FACILITIES ACCESS WAY A riparian buffer authorization is required for pier and docking facilities access ways through the Tar -Pamlico & Neuse River Riparian buffer per Division of Water Quality (DWQ) regulations 15A NCAC 02B.0233 & .0259, The Division of Coastal Management (DCM), through a Memorandum of Understanding with the Division of Water Quality (DWQ) has reviewed your project proposal, determined that the project as proposed complies with the aforementioned regulations, and made a "no practical alternatives" determination per those regulations. Those activities covered by your Coastal Area Management Act (CAMA) permit have received Buffer Authorization as long as the project is constructed in a manner that continues to meet all of the conditions listed below. Failure to comply with this Buffer Authorization shall subject the property owner & the party (contractor) performing the construction Wor land clearing to a civil penalty of up to $25,000 per day per violation. 1. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft. riparian buffer perpendicularly (which is defined as between 75 and 105 degrees) unless otherwise approved by DCM. The alignment shall minimize the removal of woody vegetation to the greatest extent practicable. 2. Pervious Materials: All reasonable measures shall be taken to ensure the access way is made of pervious materials like open -slatted wood or composite, mulch, or grass to meet the intent of the rules to the maximum extent practicable. 3. Access Width: The width of the pier or docking facility access way shall be limited to six (6) feet. 4. Project Drawing: The drawing on the CAMA General Permit is considered the project drawing of your property indicating the relative location of the pier or docking facility and any requested access way. This drawing will be used to aid in compliance and monitoring efforts. By your signature below you agree to be held responsible for meeting all of the conditions listed above and verify that all information provided is complete and accurate. ke!�Ipr Applicant Printed Name Permit Of# cer's Signature 2� 1 gen r Applicant Signature Issue D to CAMA GENERAL PERMIT #: S71 Washington Office Morehead City Office 943 Washington Square Mall 400 Commerce Avenue Washington, NC 27889 Morehead City, NC 28557 Phone 252-946-6481 Phone 252-808-2808 An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper Version 5, 0912009 NC Division of Coastal Mgt. Habitat Impact Computer Sheep Applicant: Tate Garay Date: 3/28/11 Permit #: 57176C Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement found in your Habitat code sheet. Habitat Name DISTURB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FINAL Sq. Ft. (Anticipated final disturbance. Excludes any restoration and/or temp impact amount) TOTAL Feet (Applied for. Disturbance total includes any anticipated restoration or temp impacts FINAL Feet (Anticipated final disturbance. Excludes any restoration and/or temp impact amount Open Water Dredge O Fill ❑ Both ❑ Other 0 1480 1480 Dredge ❑ Fill O Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ 252-808-2808 :: 1-888-4RCOAST :: www.nccoastaimanagement.net revised:02/03/10 r ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/MOOREVG PIL17VGSBOATLIFTBOATHOUSE) I hereby certify that I own property adjacent to s l �(Name of Property Owner) property located at �� 9 Cl�-5���% c �� cc2 � (Lot, Block, Road, etc.) on &� �2�-E� , f2�D /�A i J/l, lV� L/�A� C. (Waterbody) (Town and/or County) He has described to me, as shown below, the development he is proposing at that location, and, I have no objections to his proposal. I understand that a pier/mooring pilings/boatli$/boathouse must be set back a minimum distance of fifteen feet (15) from my area of riparian access unless waived by me. ✓ I do not wish to waive the setback requirement. I do wish to waive that setback requirement. DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: (To be filled in by individual proposing development) (Applicant Information) Mailing Address City/StatelZip- Telephone Number Date (Riparian Property Owner Information) Signat e _ Prim or Type Name Telephone Number 3 / 2b Date 1 s /Ji r�4 7-'/L.L7 IA- -TZ=-r-r> I IQ i NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary Date: March 22, 2011 Name of Property Owner Applying for Permit: Jennifer and Tate Garey Mailing Address: 4005 Grandbridge Drive Apex, NC 27539 I certify that I have authorized (agent): Bobby Cahoon Marine Construction to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity): Removal of an old dock and Installation of a new dock at (my property located at): This certification is valid thru (date): Property Owner Signature: Jennifer Garey 809 Osprey Court New Bern, NC 28560 Project Completion (Est. May 1, 2011) Date: March 22, 2011 400 Commerce Avenue, Morehead City, North Carolina 28557 Phone: 252-808-2808 X FAX: 252-247-3330 \ Internet: www.nccoastaimanagement.net An Equal Opportunity \ Affirmative Action Employer - 50% Recycled \ 10% Post Consumer Paper hr9ar25 11 08:08a Teresa Cahoon 252-249-0884 NC®ENR North Carolina Department of Environment and Natural Resources pivision of Coastal Management apve iy Fares petdue, Govemor James K Gregson, nirector Dee Freeman, Secretary Date 14 '2" � L' � 2-L _Tame u€X'roperty ()►rner Applying for Permit: Mailing Addre'titi- A-P! i r�f Cff p.2 r eertifc that i have II)rborized (agent) —Qx tr - to act Oil my behalf, forthe purpose of applying €or and Obtaininb 1Il CAM Fcrmitg neemsary to install Pr construct (activity) at (my property tocared at) 17 This certification is Vulid thru (date) Z. L- ter Sizn Zj-Z2-II Date 400 Gomm = Avenue, Morehead City, North Carolina 2a557 Phone: 252-808.28081 PAX: 252-24733301 Iniemet www,ncmastelrnanapementriot An fiqual OppWtrniy 1 AVM9,ve Alton EMPto7er -5n RecydeV,10% pwiconwrnet Paper BOBBY CAHOON RINE CONSTRUCTION AND LAND DEVELOPMENT DBA BOBBY CAHOON CONSTRUCTION, INC. 6003 NEUSE RD. GRANTSBORO, NC 28529 PH (252) 249-1617 HE F_ o--zJ 1) � 1? ) C WACHOVIA BANK, NA APEX, NC 27502 66-021 /530 II'0096961I' I:OS3000 2 L91: 20000 L76848 281I' ��--��DOLLARS 8 3/25/2011 USPS - Track & Confirm AGUNITED STATES POSTAtL SERVICE, : Home I Help I sign In Track & Confirm FAQs Track & Confirm Search Results Label/Receipt Number: 7007 1490 0001 5445 3347 Service(s): Certified Mail"o Status: Notice Left We attempted to deliver your item at 12:20 pm on March 17, 2011 in WASHINGTON, DC 20024 and a notice was left. You may arrange redeliverybyvisibngwww.usps.com/redelive or calling 800-ASK- USPS, or may pick up the item at the Post Office indicated on the notice. If this item is unclaimed after 15 days then it will be returned to the sender. Information, if available, is updated periodically throughout the day. Please check again later. Detailed Results: • Notice Left, March 17, 2011, 12:20 pm, WASHINGTON, DC 20024 • Arrival at Unit, March 17, 2011, 8:53 am, WASHINGTON, DC 20024 Track & Confirm Enter Label/Receipt Number. Go > Notification Options Track & Confirm by email Get current event information or updates for your item sent to you or others by email. Goy. Site Map Customer Service Forms Gov't Services Careers Privacy Policy Terms of Use Business Customer Gateway Copyright© 2010 USPS. All Rights Reserved. No FEAR Act EEO Data FOIA asps.com/.../InterLabelInquiry.do 1/1 Cs�A 6Z'e_.c� a m m LrI _-I- -I- Postage $ 7 ^ t11� � ul Certified Fee 8 r �< � � E3 p Return Receipt Fee (Endorsement Required) �po,stmark p Restricted Delivery Fee Required) 1-3(Endorsement Q' .� i = r9 Total Postage & Fees $ C`- Sent To p Street, A P. No.; or PO Box No. 3 No. • 1 3 r S:T. -------- --------- Ciry, State, ZfP+4 cTa a -Q m m Lr-I — Postage S 4 LfI Certified Fee A p p Return Receipt Fee (Endorsement Required) 3 0 Restricted Delivery Fee p (Endorsement Required) & Fees $ ' Total Postage r� Sent To 5 v iL vx FL p Street, Apt. No.; ii C �' S�� or PO Box No. t J ------ -- Cit}, State, ZIP+4 t C_a_a ay