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HomeMy WebLinkAbout42730_BRIGGS, GEORGE_20050909CAI�f=A / El DREDGE &FILL � _ ` W ` 11 IZ U N° 427301r, avaew ENERAL PERMIT Previous permit# El Modification ❑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 I SA NCAC l� U ulf s attached. Applicant NameG E'Or5c- �r % ci cif Project Location: County I� i T e-/ C-1: Address 6 2 kqh 6/t ti i Yr Street Address/ State Road/ /Lot #(s) City �C.ALA40r--f — State � C ZIP r2 rl �, 6 �f'rz�c:Xc. i /I f Phone # Fax # ( ) Subdivision Authorized Agent 'eu 04,4 City PAG vfi ZIP Affected El�FFt CW �A El ES ES PTS Phone # ( ) River Basin O'Y ❑ oEA ❑ HHF ❑ IH [I( USA ❑ N/A Adj. Wtr. Body 1✓ AEC(s): o� (-� I 1 ll-pr' nat) /man /unkn) ORW: yes fn—) PNA yes / oo Crit. Hab. yes / no Closest Maj. Wtr. Bodyram, Type of Project/ ActivityC/ O c: L -70f i X G 2 4/, -,/ y •', (Scale: /✓, — ) Pier (dock) length !' O XT — — -- — - -- Platform(s) 2 G 'K / U 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 i (,�'Av-,✓1-C ( 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: I Notes/ ISpecial Conditions +� ° < <� fkafl 1q ,. rt" PLC i"u'q CJ� (_i" ri-tN n C 1 Agent Signatule re 7P,,read compliance statement on back of permit ylfl Application Fee(s) Check # Issuinbatel Expiration Date r�✓y TO Local Planning Jurisdiction Rover File Name 1 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 I) 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, certifythat 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 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 Fax: 919-733-1495 Fax: 252-264-3723 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans Counties) Morehead City District 400 Commerce Ave Morehead City, NC 28557 202-808-2808/ 1-888-4RCOAST 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 910-796-7215 Fax: 910-395-3964 (Serves: Brunswick, New Hanover, Onslow below New River Inlet- and Pender Counties.) is DEC 0 9 2005 Morehead City DC� Revised 06/29/05 Rene R. E. Briggs 66-30/ 05 4235 George A. Briggs P.O. Box 921 Be¢uf,,t, NC 28516 DATE �S pi -CO THE O!:DER OF .—.— -- - - _ J-- _— DOLLARS ' Louk lor. Micro Nint signature Ilnc, gray y and lincworl. First Citizens Bank logo on back. I(not present, do not cash. FIRST CITIZENS 005 1 , NK pirst-Citizona BanK &Trust Company l�lV Fioaulart, N.C. 285t6� W—fi stdt�ens.com IIIVI/C�/Y�/1 1`{Ivfp�'/1_ L-7 •� IVP g.0 5 3 100 3009:0000 5 7 6 a 0 9 9,3�i' 0 �. 2 3 5 ❑ CAMA / 1:1 DREDGE & FILL GENERAL PERMIT Pre permit# L7New ❑Modification ❑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 i] Rules attached. Applicant Name 1 S Project Location: County iJ 1 Address %'� �' �� y ��� �` r1 i �1 r ► Street Address/ State Road/ Lot #(s) City l .; r"' r? t � �(f • State ZIP Phone # ( ) ``.-0 — t �/ ` Fax # ( ) Subdivision Authorized Agent Z ! 1 f'�' City '. ,l l ZIP CW ❑ EW -[�fTA El ES ❑ PTS Phone # ( ) River Basin Affected D OEA ❑ HHF ❑ ElElf IH UBA N/A [ AEC(s): Adj. Wtr. Body''' �' �' I irr na an nkn ❑ PWS: ElFC: ORW: yes / no PNA yes /�oi Crit. Hab. yes / no Closest Maj. Wtr. Body n �I Type of Project/ Activity Pier (dock) length _ I I I r I I Platform(s)- Fingerpier(s) . I (1 Groin length �—i �.�' U.L number Bulkhead/ Riprap length ! I avg distance offshore I _ I max distance offshore ' � . _ i I I i i i iz- � -I- 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 9 Y be required b : Notes/ Special Conditions Agent or Applicant Prigied Name Signature Please read compliance statement on back of permit Application Fee(s) Check # Wc t � i e., 66 I ❑ See note on back regarding River Basin rules. Permit Officer's Signature Issuingt)ate? Expiration Date r Local Planningf urisdiction 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, certifythat this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: _'i Tar- Pamlico River Basin Buffer Rules Other: � Neuse River Basin Buffer Rules If indicated on front of permit, your project is subject to the Environmen.al 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 Central Office Mailing Address: 1638 Mail Service Center Raleigh, NC 27699-1638 Location: Parker -Lincoln Building 2728 Capital Blvd. Raleigh, NC 27604 919-733-2293 Fax: 919-733-1495 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) Morehead City District 400 Commerce Ave Morehead City, NC 28557 202-808-2808/ 1-888-4RCOAST 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 910-796-7215 Fax: 910-395-3964 (Serves: Brunswick, New Hanover, Orslow -below New River Inlet- and Pender Counties) Revised 06/29/05 OF_ FAX PHONE ❑ MODLE MESSAGE_ SIGNED PHONE LCA L DATE — TI M �jZ Z CODE NUMDER EXTENSION PHONED RETURNED YOUR CALL LEA------.__ SE CALL WILL CALL AGAIN -CA TCM 0 SEE YOU WANTS TO SEE YOU IRM a --- U.S. er SeMms LINDA RIKE REAL ESTATE, LINDA RIKE & ED DAUGHETY 1410 ARENDELL STREET MOREHEAD CITY, NC 28557 WWW.LINDARIKE.COM E-MAIL: LINDA@LINDARIKE.COM eAXW 'lU Q GRI FAX: (252) 247-6936 UNITED STATES POSTAL SERVICE .TA.04 FkA F i... 19 'Au • Sender: Please print your name, address, and ZINW n this box c,6blZ6E A MCGS 1'd -6 Q }C `5z j -7,LFAoFbc -r- 1�,C'.2.?SIG III It Iflilt IIIIfi „:I1I1,I,I1111111.)11111111itfill ■ Complete items 1, 2, and 3. Also complete A. Signature item 4 if Restricted Delivery is desired. XC.�,� ■ Print your name and address on the reverse so that we can return the card to you. B. R eived b (Pri j ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: ❑ Agent ❑ Addressee ?=P I C. Date of DelivEW_'� D. Is delivery address d4rent fr= item 1? ❑ If YES, enter delivery" ddres low: 0 (p rTi y 2) i � I 3. Service Type r "+ ❑ o � Certified Mail �� apr,.%Mail ❑ Registered RetwAoleceipt for M =.,L ❑ Insured Mailer C.O-q M. 4. Restricted Delivery? (Extra F;Z 11 2. Article Number (Transfer from service la 7003 3110 0002 9873 9692 PS Form 3811, February 2004 Domestic Return Receipt 1 Toqo 1IRA ADJACENT RIPARIAN PROPERTY OWNER STATEMENT (FOR A PIER/VIOORING PILINGSIBOATLIFT/BOATHOUSE) I hereby certify that I own property adjacent to s (Name of Property Owner) property located at (Lot, Block, Road, etc.) 'CD on in L�� �i�RE� 0 1�tzTrt R��/'C P N.C. (Waterbody) ff new— aridWer County) 7. 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/boatlift/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. DESCRIPTIONAND/OR DRAWL\G OF PROPOSED DEVELOPMENT: (To be filled in by indi�'idual proposing development) Si;nature Print or Type Name 71�3 - �--',W Telephone Number Date: Rosi , «-E r o SECTION .1200 - GENERAL PERMIT FOR CONSTRUCTION OF PIERS: DOCKS: AND BO@' HOUSE, ESTUARINE AND PUBLIC TRUST WATERS AND OCEAN HAZARD ARC, ASZ' � CD -„ 15A NCAC 07H .1201 PURPOSE �C kf, A permit under this Section shall allow the construction of new piers, docks, and boathouses in the estuarinnid pufMic trust waters AECs and constriction of new piers and docks within coastal wetlands AECs according to the auth ty prdt�ded in Subchapter 07J .1100 and according to the Rules in this Section. This permit shall not apply to oceanfrooreli&s or to waters and shorelines adjacent to the Ocean Hazard AEC with the exception of those shorelines that feature 4i -acteristies_ of the Estuarine Shoreline AEC. Such features include the presence of wetland vegetation, lower wave en r0y, and love er erosion rates than the adjacent Ocean Erodible Area. History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-118.1; 113A-124; Eff. March 1, 1984; Amended Eff. April 1, 2003. 15A NCAC 07H .1202 APPROVAL PROCEDURES (a) The applicant must contact the Division of Coastal Management and complete an application form requesting approval for development. The applicant shall provide information on site location, dimensions of the project area, and his name and address. (b) The applicant must provide: (1) confirmation that a written statement has been obtained signed by the adjacent riparian property owners indicating that they have no objections to the proposed work; or (2) confirmation that the adj acent riparian property owners have been notified by certified mail of the proposed work. Such notice shall instruct adjacent property owners to provide any comments on the proposed development in writing for consideration by permitting officials to the Division of Coastal Management within 10 days of receipt of the notice, and, indicate that no response will be interpreted as no objection. DCM staff shall review all comments and determine, based on their relevance to the potential impacts of the proposed project, if the proposed project can be approved by a General Permit. If DCM staff finds that the comments are worthy of more in-depth review, the applicant shall be notified that he must submit an application for a major development permit. (c) Approval of individual projects shall be acknowledged in writing by the Division of Coastal Management and the applicant shall be provided a copy of this Section. (d) Constriction must be completed within 90 days of the approval of the permit or the permit expires. (e) Any modification or addition to the approved project shall require prior approval from the Division of Coastal Management. History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-118.1; 113A-124; Eff. March 1, 1984; Amended Eff. August 1, 1998; January 1, 1990. 15A NCAC 07H .1203 PERMIT FEE The applicant must pay a permit fee of one hundred dollars ($100.00) by check or money order payable to the Department. History Note: Authority G.S, 113A-107; 113A-113(b); 113A-118.1; 113A-119; 113-119.1; 113A-124; Eff. March 1, 1984; Amended Eff. August 1, 2000; March 1, 1991. 15A NCAC 07H .1204 GENERAL CONDITIONS (a) Piers authorized by this general permit shall be for the exclusive use of the land owner, or occupant and shall not provide either leased or rented docking space or any other commercial services. Piers designed to provide docking space for more than two boats shall, because of their greater potential for adverse impacts, be reviewed through the major permitting process and, therefore, are not authorized by this general permit. (b) lndividuals shall allow authorized representatives of the Department of Environment and Natural Resornrces to ma%e ti periodic inspections at any time deemed necessary in order to be sure that the activity being performed under the authority of this general permit is in accordance with the terms and conditions prescribed herein. (c) There shall be no unreasonable interference with navigation or use of the waters by the public by the existence of piers, docks and boat houses. (d) This permit will not be applicable to proposed construction where the Department believes that the proposed activity might unnecessarily endanger adjoining properties; significantly affect historic, cultural, scenic, conservation or recreation values, identified in G.S. 113A-102 and G.S. 113A-113(b)(4), nor that might significantly affect the quality of the human environment. (e) This permit does not eliminate the need to obtain any other required state, local, or federal authorization. (f) Development carried out under this permit must be consistent with all local requirements, AEC Guidelines, and local land use plans current at the time of authorization. History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-118.1; 113A-124; Eff. March 1, 1984; Amended Eff. May], 1990; RRC Objection due to ambiguity Eff. May 19, 1994; Amended Eff. August 1, 1998; July 1, 1994. 15A NCAC 07H .1205 SPECIFIC CONDITIONS (a) Piers, docks, and boat houses may extend or be located up to a maximum. of 400 feet waterward from the normal high water line or the normal water level, whichever is applicable. (b) Piers, docks, and boat houses shall not extend beyond the established pier length along the same shoreline for similar use. This restriction shall not apply to piers 100 feet or less in length unless necessary to avoid unreasonable interference with navigation or other uses of the waters by the public such as blocking established navigationroutes or interfering with access to adjoining properties. The length of piers shall be measured from the waterward edge of any wetlands that border the water body. (c) Piers longer than 200 feet shall be permitted only if the proposed length gives access to deeper water at a rate of at least one foot at each 100 foot increment of pier length longer than 200 feet, or if the additional length is necessary to span some obstruction to navigation. Measurements to determine pier lengths shall be made from the waterward edge of any coastal wetland vegetation, which borders the water body. (d) Piers and docks shall be no wider than six feet and shall be elevated at least three feet above any coastal wetland substrate as measured from the bottom of the decking. (e) Any portion of a pier (either fixed or floating) extending from the main structure and six feet or less in width shall be considered either a "T" or a finger pier. (f) Except in the case of boat houses, any portion of a structure (either fixed or floating) greater than six feet wide shall be considered a platform or deck. (g) "T"s, finger piers, platforms, and decks of piers on lots with shorelines 100 feet or greater in length shall not exceed a combined total area of 400 square feet. The combined total area for lots less than 100 feet shall not exceed four square feet per linear foot of shoreline. (h) Platforms and decks shall have no more than six feet of any dimension extending over coastal wetlands. (i) The width requirements established in Paragraphs (d), (e), (0, (g) and (h) of this Rule shall not apply to pier structures in existence on or before July 1, 2001 when structural modifications are needed to prevent or minimize storm damage. In these cases, pilings and cross bracing maybe used to provide structural support as long as they do not extend more than of two feet on either side of the principal structure. These modifications may not be used to expand the floor decking of platforms and piers. 0) Boathouses shall not exceed 400 square feet and shall have sides extending no further than one-half the height of the walls as measured in a downward direction from the top wall plate or header and only covering the top half of the walls. Measurements of square footage shall be taken of the greatest exterior dimensions. Boathouses shall not be allowed on lots with less than 75 linear feet of shoreline. (k) The area enclosed by a boat lift shall not exceed 400 square feet. (1) Piers, docks, decks, platforms and boat houses shall be single story. They may be roofed but shall not be designed to allow second story use. (m) Pier alignments along federally maintained channels must also meet Cores of Engineers regulations for pier construction pursuant to Section 10 of the Rivers and Harbors Act. (n) Piers, docks, and boat houses shall in no case extend more than 1 /4 the width of a natural water body, human -made canal or basin. Measurements to determine widths of the water body, human -made canals or basins shall be made from the waterward edge of coiist:al wetland vegetation which borders the water body. The 1/4 Length limit Ition shall not apply when the proposed l: i is located between longer piers within 200 feet of the applicant's property. however, the proposed pier shall not be longer than the pier head line established by the adjacent i piers, nor, longer than 1/3 the width of the water body. (o) Piers, docks and boat houses shall y ,k not interfere with the access to any riparian property, and shall have a minimum setback of 15 feet between 7 r' any part of the pier and the adjacent property lines extended into the water at the points that they intersect the shoreline. The minimum setbacks provided in the rule may be waived by Y ^4 the written agreement of the adjacent riparian owner(s), or when two adjoining riparian owners are co -applicants. Should the adjacent property be sold before construction of _ the pier commences, the applicant shall obtain a written agreement with the new owner waiving the minimum setback and submit it to the Division of Coastal Management prior to initiating any t development of the pier, dock, or boat EXAMPLES house. The line of division of areas of RIPARIAN ACCESS AREAS riparian access shall be established by drawing a line along the channel or PRQ)ECT. AREA deep water in front of the property, then EDGE OF CHANNEL OR drawing a line perpendicular to the line —`— DEEP WATER of the channel so that it intersects with PROPERTY LINE --- RIPARIAN LIMIT the shore at the point the upland MEAN HIGH WATER property line meets the water's edge. Application of this Rule may be aided WATER by reference to the approved diagram in Paragraph (r) of this Rule illustrating the rule as applied to various shoreline configurations. Copies of the diagram may be obtained from the Division of Coastal Management. When shoreline configuration is such that a perpendicular alignment cannot be achieved, the pier shall be aligned to meet the intent of this Rule to the maximum extent practicable. (p) Piers, and mooring facilities shall be designed to provide docking space for no more than two boats. (q) Applicants for authorization to construct a dock or pier shall provide notice of the permit application to the owner of any part of a shellfish franchise or lease over which the proposed dock or pier would extend. The applicant shall allow the lease holder the opportunity to mark a navigation route from the pier to the edge of the lease. (r) The diagram shown below illustrates the various shoreline configurations: History Note: Authority G.S. 113A-107(a); 113A-107(b); 113A-113(b); 113A-118.1; 113A-124; Eff. March 1, 1984; Amended Eff. December 1, 1991; May 1, 1990; March 1, 1990; RR Objection due to ambiguity Eff. March 18, 1993; Amended Eff. August 1, 1998; April 23, 1993; Temporary Amendment Eff. December 20, 2001; Amended Eff. April 1, 2003. 900 1 `y 'r>'u�ZJ'�duyr 1 frF ti1FE=• � lrtiA 1parian Corridor x �a is La"CZ �idcrx 10 r 3tib,361 r rnm 5 }� i G Pro peit,r Civnier Name <v BERG �Ai9r 5 F'rc�T.,rrt�j L.ii}e !,,.it,.,.r or, gl.�ilu} s l�� ��r• r�}. }Tr 0 Normal L O'?* '!t1'9t?1 1 d? 35LIt?221a',L t +- :f Nin , 'L k.• D i ... .- ,GMCIOT i0 , i'1 will iu «t0 k1Y �1 rQpt tlilarii 2'ti �T 900 Dirner},ion:; of "Taaor"L" or other platfonns ff nger piers Distance o-rer I',el h �vldth 61-6 a Distance from I•,-iarsh or p Vater Level ivldch ever applies or both Si.rnple Nloifh crow— r Spot Water Depths Ripa?ian Conido r y i� ,�I• I tt ,' 1d�tiFL,1lH�,f,or I-TUR L,Jt 55'Idth I?al:c_c-le where the j Nur_tu'Yti }{�.?i iBii}fit' iFa'. 11G'i Property Owner Larne, Address, Location Elate fl�R6�,p GGR�v; M L� 7 CERTIFIED MAIL - RETURN RECEIPT REQUESTED DIVISION OF COASTAL iNI_A.NAGE-�N s ADJACENT RIPARIAN PROPERTY ONy�`ER NOT IFIC f . FORM f AUG 29, 2005 Name of individual applying for permit: Ch15 o RC-4 '— %mod CrtY Address of property: �►� 1—£t�»zc�C 1ti�E CM (,ot or street #, street or road) (City & County) I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit has described to me (as shown on the attached drawing) the development they are proposing. A description or drawing, with dimensions, should be provided with this letter. _ I have no objections to this proposal. If you have objections to what is being proposed, please write the Division of Coastal Management, 400 Commerce Ave., Morehead City, NC 28557 or call (252) 808-2808 within IO days of receipt of this notice. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift or sandbags must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the appropriate blank below.) I do wish to waive the 15' setback requirement. X I do not wish to waive the 15' setback requirement. ��- ' rl r f' li Sig ture Date Print Name ,P13 23 6- A412— Telephone Number With Area Code i'0urn vttvivt requf,—,wJ.aBa 83c cat r'7ip.j'%;Fs Rene R. R. Briggs George A. Briggs P.O. Box 921 Beaufort, NC 28516 66-30/531 005 I'AY [O TI11 �t, e l v �1� �t CiC ORDER OI � f I mi, lur Mimi vrinl slgnalurc line. p,n �BANKnRsr OTIZENs OAS Cl tar(e1oti (" Fiat C11"m 8*nI.T,usl Company _ BoauloA. N.C. 28576 y� ,,,,,,w.nrstdUs.ns.com 40 � .- Iol.�x�_fi.sr-=- ,:053L00300':00005268099311' 4151 J