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HomeMy WebLinkAbout42711_DILDY, KELLY_20050817❑ gAMA / E DREDGE & FILL GENERAL PERMIT ' Previous permit # ❑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 I Rules attached. Applicant Name Project Location: County Address_ Street Address/ State Road/ Lot #(s) City State ZIP Phone # ( ) Fax # ( ) Subdivision Authorized Agent City ZIP Affected ❑ CW ❑ EW ❑ PTA 1 ES ❑ PTS Phone # ( ) _QQ River Basin AEC(s): ElOEA C HHF ElIH ❑ UBA -El N/A Adj. Wtr. Body /JODLA.0 rpt4,NiJiDf /unkn) ❑ PWS: C FC: —o�U � ORW: yes / no PNA yes / no Crit. Hab� Q Closest Maj. Wtr. Body . yes / no —�— Type of Project/ Activity Pier (dock) length Platform(s) Finger pier(s) Groin length number Bulkhead/ Riprap length_ avg distance offshore max distance offshore Basin, channel cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other 7-1 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 v.(4` Agent or Applicant Printed Name 4 Signature ** Please read compliance statement on back of permit" (Scale: ) I I See note on back regarding River Basin rules. Permit Officer's Signature I Issuing Date Expiration Date Local Planningf urisdiction Rover File Name Application Fee(s) Check # 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: l Tar - Pamlico River Basin Buffer Rules ] Other: 11 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: Fax: 252-264-3723 Parker -Lincoln Building 2728 Capital Blvd. Raleigh, NC 27604 919-733-2293 Fax: 919-733-1495 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans Counties) Morehead City District 400 Commerce Ave Morehead City, NC 28557 202-808-2808/ 1-888ARCOAST 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) Revised 06/29/05 1 Fo 'm DCNI-W-1 MOrehead City DC M m. Describe exi ting`wanu r eatment i1_' 4. LAND AND WATER CHARACTERISTICS � . a. Size of entire tract U2MRMS� I b Size of individual lot(s) oo�� r6� c, Approximate ilevation f tract above MHW or NWL Soil type(s) arid texture(s) of tract 5 UQOVr \ Vegetation on tract .v-,c ,�0. {ram 0 LtiS F, Man-made features now on tract g. What is the CAMA Land Use plan land classification of the site? (0__Lf v>< 10,31 Land "se pl=-) Conservation Transitional Developed Community Rural Other h. How is the tract zoned by local government? i. Is the proposedproje� consistent with the applicable .✓/ zoning? Yes No ('lntach Zoning conFli", "rrifimu, t z ) j. Has a professional archaeological assesont been done for the tract? Yes If yes, by whom? Is the project located in a National Registered Historic District or does it involve a National Register listed or el' le property? Yes No o e site? Yes No Are there wetlands Coastal (marsh) � Other If yes, has a delineation been conducted? (Aaach docu�on, if available) ❑. Describe location and type of discharges to waters of the state. (For example, surface runoff, sanitary wastewater, industrial/commercial effluennt� wash down- �d residential discharges.) S --- o. Describn�stin`g dry �µ'ater supply source. 5. ADDITIONAL INFORMATION In addition to the completed application form, the following items must be submitted: • A copy of the deed (with state application only) or ocher instrument under which the applicant claims title to the affected properties. If the applicant is not claiming to be the owner of said property, then forward a copy of the deed or other instrument under which the owner claims title, plus written permission from the owner to carry out the project. 0 An accurate, dated work plat (including plan view and cross -sectional drawings) drawn to scale in black ink on an 8 1/2" by 11" white paper. (Refer to Coastal Resources C(,mmission Rule 7J.0203 for a detailed description.) please note that original drawings are preferred and only high quality copies will be accepted. Blue -line prints or other larger plats are acceptable only if an adequate number of quality copies are provided by applicant. (Contact the U.S. Army Corps of Engineers regarding that agency's use of larger drawings.) A site or location map is a part of plat iNuirements and it must be sufficiently detailed to guide agency personnel unfamiliar with the area to the form DCM-NIP-1 APPLICATION (To be completed by all applicants) 1. APPLICANT a. Landowner: `I Name KE LL-J Ll) -1 Address a 5 Q� 1 City W I State r C Zip t; '7S41?J' Day Phonj�;5�o? 6' !3y 19 t . Authorized A�egt: Name �&&W WFF,—r> Address P b A 05 City' ► fern-TTy C r'[-f State 0_ b. City, town, community or landmark f A a (4E} 0 c rr'i c. Street address or secondary road number a 31 t Cuf�Ns S-c- d. Is proposed work wi in city limits or planning jurisdiction? Yes No e. Name of body of water nearest roject (e.g. river, creek, sound, bay) 3ciCW VDUrl� 3. DESCRIPTION AND PLANNED USE OF PROPOSED PROJECT a. List all development activities you propose (e.g. building a home, motel, marina, bulkhead, pier, and excavation and/or filling activities. L U— Zipd�S % Day Phor(eQ— 3%�� b. IS the proposed activity maintenance of an existing project, new work, or both? t!51AQ—r16 c. Will the ro)ect be for public, private or commercial use? c . Project name (if any) D NOTE: Perrrct will be issued in name of landawner(r), and/or project name. ... LOCATION OF PROPOSED PROJECT d. Give a brief description of purpose, use, metbods of construction and daily operations of proposed project. if mores ace is needed, please attach additional pages. ft RBL.E t. County C-Pr`�� U-r_� Fc rm DCM-NIP-1 site. Include highway or secondary road (SR) numbers, landmarks, and the like. • A Stormwater Certification, if one is necessary • A list of the names and complete addresses or the adjacent waterfront (riparian) landowners and signed return receipts as proof that such owners have received a copy or the application and plats by certified mail. Such landowners must be advised that they have 30 days in which to submit comments on the proposed project to the Division of Coastal Management. Upon signing this form, the applicant further certifies that such notice has been provided. Name L11� �►00-D G?LICC Address Q3a9 c60'P045 S-t- MT' — Phone PhoneAddress Name Address Phone • A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and issuing dates. • A check made payable to the Department of Environment, Health, and Natural Resources (DEHIv'R) to cover the costs of processing the application. • A signed AEC hazard notice for projects in oceanfront and inlet areas. • A statement or compliance with the N.C. Environmental Policy Act (N.C.G.S. 113A - 1 to 10) If the project involves the expenditure of public funds or use of public lands, attach a statement documenting compliance with the North Carolina Environmental Policy Act. MAY 6. CERT410 ON AND i;6NT' ISSION TO ENTER ONP tj, C '' -t�1-- I understazid that any permit issued in response to this application will allow only the development described in the application. The project will be subject to conditions aad restrictions contained in the permit. I certify that to the best of my knowledge, the proposed activiry:Fomplies with the State of North Carolina's approved Coastal Management Program and will be conducted in a manner consistent with such program. I certify that I am authorized to grant, and do in fact, grant permission to representatives of state and federal review agencies to enter on the aforementioned lands in connection with evaluating information related to this permit application and follow-up monitoring of the project. I further certify that the information provided in this application is truthful to the best of my knowledge. Tbis is the day of , 19 Print Name G ���� W�op Signature C- Lmtdowner or Authorized Agew Please indicate attachments pertaining to your proposed project. DCM MP-2 Excavation and Fill Information CM MP-3 Upland Development DCM W-4 Structures Information — DCM MT-5 Bridges and Culverts — DCM MP-6 Marina Development NOTE: Please sign and date each attachment in the space provided at the bottom of each form. Form DCM1-.'ylT4 STRUCTURES (Constriction within Public Trust Areas) Attach this form to Joint Application for CAMA Major Permit, Form DCM-MP-1. Be sure to complete all other se:;tions of the Joint Application which relate to this prof: osed project. a. Doc c(s) and/or Pier(s) I (1) — Commercial _Community _ Private (2) Number M Lene--n 1 CIS (4) Width (3) Finger Piers Yes ✓ No (1) Number --IS�- (i1) Len27.h (iii) Width �- (6) Platforms) __LYes No (1) Number I (ii) Length as (iii) Width 1 o (7) Number of slips proposed (8) Proximity of strucalre to adjacent riparian prope.rcy Iines I S '-I- (9) Width of water body _tO� Y'nit� (10) Water depth at wa_e ward end of pier at MLW or Ir W"L 3 ' IX\ L%.0 b. Boathouse (including coverer life)�� (1) "'�Eommerc:al Private (2) Leng-.h (3) Width c. Groin (e.g. wood, shecmiie, etc.) (1) Number (2) Length(s) �- d. Bre3kw•ater (e.g. wo , sheetpile, etc.) (1) Length (2) Average distance from MHW, NWL or Wetlands (3) Maximum dista,�,�e beyond MHW, NWL or wetlands -� e. Mooring buoys (1) — Commercial _Community V Private (2) Number 1 (3) Description of buoy (Color, inscription, size, anchor, etc.) __I -T IE 9&406 (4) Wids of water body 1 M 1lr (3) Diszance buoy(s) to be placed beyond siloreiine 0 13O f. Mooring strucrure (boadift, mooring pilingss etc.) (1) _ Commercial _Community ✓ Private (2) Nu„ .ber a (3) Lenzi 13 10 13' g. Other (G:,e ec.- iere drs. o.^•'on) D 11. Dq Applicant or P-oj ,c Name�` A n Signature �T�1 Date • �lOr a CAMA Major Development Permit Application Checklist�6� <:GS �C This checklist is provided solely as an informational resource for permit applicants. A prospective applicant is not S d`. required to fill out this checklist. It is also not required that this checklist be provided to the Division. Pre -application Meeting While it is not required, you are strongly encouraged to schedule apre-application site visit with a LAMA field representative. Such a meeting can greatly aid in expediting the review of your permit application. PERMIT APPLICATION FORMS Application Forms All applicants must completely fill out all three pages of form DCM MP-1. Depending on the scope of your proposed development, you will need to fill out some or all of the additional forms listed below: DCM MP-2 Excavation and Fill DCM MP-5 Bridges and Culverts DCM MP-3 Upland Development DCM MP-6 Marina Development DCM MP-4 Structures Information DCM MP-7 Urban Waterfront • All questions on the application forms must be completed or the letters "NIA" must be placed in each item that does not apply to your proposed project. • All of the information provided in these forms trust accurately correspond with the submitted workplan drawings. WORKPLAN DRAWINGS • Drawings must be neat, clear, and of standard size to permit photographic reproduction. If blue prints or sheets larger than I I" x IT, are used, 25 copies must be submitted (it may be advisable to request that a CAMA field representative inspect a final copy of the work -plan drawing(s) prior to making the required 25 copies). • Each drawing must have a simple title block, which should include the applicant's name, drawing number (i.e. Page 1 of 4), and the date the application was prepared. Undated drawings cannot be accepted. • The workplans must be accurately drawn to scale (I" =200' or less). The scale must be indicated on each drawing. • Location Map Your application must include a map showing the location of the proposed work or development. This map must provide adequate information to allow someone unfamiliar with the project area to locate the project site. Top or Plan View Drawing Your application must include a drawing(s) showing the following: o Existing and proposed features (i.e. dunes, shorelines, water bodies, marsh lands, wetlands, existing and proposed man-made structures, exact areas and dimensions of proposed excavation, fill and/or spoil disposal, existing water depths, approximate mean high, low, and average water levels, property boundaries and riparian corridors, width of the adjacent water body, distance of proposed structures(s) to federally maintained charnels, and names of adjacent property owners). Standard north arrow. Cross -Sectional (Side -View) Drawing Your application must include a cross -sectional or side -view diagram(s) showing the following: o Depth and elevation of existing structures and the proposed work relative to the existing ground level. o Elevations of adjacent dunes (if applicable). Mean low water and mean high water lines. First floor elevations relative to mean sea level for any proposed buildings. Project Narrative A character puPo e of the propoon of the sed d velopmentroject ,construct on methodologies and any other special also be provided. Th character purpose considerations. Z(e� 2005 Application Fee C SDepartmentAMA Your application package must include a check for the appropriate fees associated with your Project (See field Environment and dfNatn al Resources). NOITE: Therec` ill beshould a $25.00 Service charge onle to all chcks. of Environm Deed l instrument Your permit application package must include a copy of a deed, purchase agreement, or other lega under which the applicant claims the right to develop the property in question. Consultant or Authorized Agent permit, you must provide a letter granting your If an authorized agent has been retained to obtain your CAMA p agent the right to apply on your behalf. Wetland Delineation Approval If applicable, documentation of U.S. Army Corps of Engineers wetland delineation approval should be provided. Adjacent Property Owner Notification Certified letters pr (Return eipt lan drawings))must beesenttes of the to all adjacent property o1wners. The(signed application truth forms and appropriate P receipt(s) must be0provided with t any Objections or concerts they l have about your proposed development pmentlshould be adjacent property provided in writing to the Division of Coastal Management. Stormwater Management Plan Certification If your proposal management plan to the NC Division of Water Qual'►t.yincrease in built -upon area on your f oorreview and approvaerty, you may be l. You are advised that the Division of Co P permit until this approval has been obtained. the Division of Coastal Management cannot issue a CAMA pe Ocean and Inlet Hazard Notices For projects within oceanfront and inlet areas, an Area of Enviroruri ennittre res trtativAeEC) Hazard Notice Form must be signed. This form is available from your local CAMA p P Other Information of Coastal Management, additional information may be requested. At the discretion of the Division For more information, refer to the North Carolina Administrative Code Section 7J.0200 — Application Process. Copies of this Section are available from the Division of Coastal Management. O �y rOhO os� CARTERET COUNTY 12901 07/ 11 /2003 91, S30.00 STATE OF .�:� Real Estate Li f�Q1pLINA ' Excise Tax 41 J Melanie Arthur CARTERET PL Date 07/11/2003 OR 1004388 2P COUNTY Time 16:40:00 Page 1 of 2 4ORTH CAROLINA, CARTERET COUNTY F foregoing ce►titicate(s) of Notary Public(s) is/are C itied to be correct. This instrument and this certifi Fate are duty registered st the date and time and in the Book and Page shown on the first Page hereof. Prepared by: The Harris Law Firm, PLLC lartre Arthur star of Deeds Parcel # 638617013463 Excise Tax $1,550.00 File No. 7802/DILDY-K.X NORTH CAROLINA GENERAL WARRANTY DEED This DEED made this the day of July, 2003, by and between ROGER L. CROWE, JR. AND WIFE, KATHERINE M. CROWE, hereinafter "Grantor" and KELLY W. DIL.DY, P.O. Box 7175, Wilson, NC 27895, hereinafter "Grantee". The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context. WITNESSETH: That the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in Morehead Township, Carteret County, North Carolina and more particularly described as follows: Being located in the Town of Morehead City, Morehead Township , Carteret County, North Carolina, and being the three tracts below described: TRACT I: Being all of Lot 10, Block 43, Town of Morehead City, as said lot is depicted on that plat of record in Map Book 1 , page 139, Carteret County Registry. TRACT II: Being the East one-half of Lot 8, Block 43, Town of Morehead City , as said lot is depicted on that plat of record in Map Book 1, page 139, Carteret County Registry, and being more particularly described as follows: Being all of said Lot 8 South of and contiguous to Lot 10, Block 43, Town of Morehead City, and North of the mean highwater mark of Bogue Sound, also conveyed is all of that property located North of the mean highwater mark of Bogue Sound and South 6f the South line of Lot 8. TRACT III: Beginning at a stake at the southeast corner of the intersections of Evans Street and 24th Street and runs thence with the south side of Evans Street, South 84 ° 15 'East 50 feet to an iron stake; thence South 5° 45 'West 168 feet to the highwater mark of Bog u d• t ence with the BOO PAC, �01 highwater mark of Bogue Sound in a westerly direction with the highwater mark of Bogue Sound North 89' 58' West 50.25 feet to an iron stake in the eastern right-of-way of 24th Street; thence with the eastern right-of-way of 24th Street North 50 45' East 173 feet to an iron stake, the point of beginning. Reference is here made to map entitled " Plot Plan for Tom Singleton, Lot 9, and portion of Lots 8 and 7, Block 43, Town of Morehead City , Carteret County, North Carolina, dated May 2, 1980." The property above -described is also in that deed recorded in Book 84, page 144, Carteret County Registry. TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and thereto belonging to the Grantee in fee simple. And the Grantor covenants with the Grantee, that Grantor is seized of the premises in 1e e, has the right to convey the same in fee simple, that title is marketable and fr,... and clear o encumbrances, and that Grantor will warrant and defend the title against the lawful cleat s of all � ersons whomsoever except for the exceptions hereinafter stated. �js Title to the property hereinabove pis subject to the following exceptions: a. S 1. Restrictive Covenants of record. 2. Public utility easements of record. IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal the day and year first above written. (SEAL) ROG R L. CROWS, JR. y� p (SEAL) KATHERINE M. CROWE STATE OF N D (+) C(JU 011 U COUNTY OF G ar+ 1,77 O� ,� )('�`f1Q1,)a Notary Public of the aforesaid County and State, do hereby certify that ROGE . CROWE, JR. AND WIFE, KATHERINE M. CROWE personally came before me this day and acknowledged the due execution of the foregoing instrument. WITNESS my hand and official star -'Awl s My Commissiort�x 4 ' F:\MSOffice\d48Uu n \tiEt)dilRy4 seal, this the _�L day of July, 2003. OOTARY PUBLIC ` =�W&�ff�AA ' P,6#1 A71- NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Michael F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., secretary r-i1 GERTIFIEDRECEIPT,. Domestic Mail Only, m Ir I A LU. S Lt Postage $ m E3 Certified Fee 0557 $2,30 O Return Receipt Fee (Endorsement Required) 02 Postmark Here ' 1.75 C3 0- Restricted Delivery Fee (Endorsement Required) $0.00 m $ $4.42 o Total Postage & Fees 05/05/?005 ul O Sent To, I� �n� u— � Yrll - ------ --- ------------------------------- ---------------------------------------- orr� treet, Apt. No.; © PO Box No. City a e,ZI + �( C —Q L r7 PS Form :rr June 2002 U.S. Postal ServiceTM CERTIFIED MAIL. RECEIPT (Domestic Mail Only, No Insurance Coverage Provided) "A USE ul Postage $ 7 CD O Certified Fee $2.30 0557 Return Receipt Fee (Endorsement Required) 02 Postmark Here $1.75 co Q' Restricted Delivery Fee (Endorsement Required) $0.00 m Q Total Postage & Fees $ $4.42 05/135/2005 L! FSent� 63 ------------------- E N- - x No. a 3�� ---------- -- -/ -- -D - S c^ r^ City,�te. z- +4 c r, June 2002 See Reverse for lnstructiorr* 400 Commerce Avenue, Morehead City, North Carolina 28557 Phone: 252-808-2808 \ FAX: 252-247-3330 \ Internet: www.nccoastalmanagement.net An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper DOCK ADDITION AND LIFT MODIFICATION PROJECT LOCATION dhvm Shoals fbop Pok atr.E "a• _Bogue Banks C:oumrV Club �FTncn Knoll Shores AREA LOCATION ll ,ipenn Point lawon Point, �Cr* el. \111age prab Pohl Neck 00k. A. 0 Are",,rt l.-12,shr. _Bw Clal Aph? Bqv F111 i Owk a"MIlis Point _�r�.� � :' CYad Pafaf lSeoso,Jure l�[}okra C}eek Ch6co LSrekAderri iggotts Bridge Marehead;Cit�r _ .+. ; ywk2 Amin v5ugarloaf Isla d Cvxkxtf CSmad vPhillips Island I �ado Island s�tr� o edarHammock MoxdLkAdky y1&7eliead dry Ckanaet —+a 4Aney Island Goat Island vTombstone Point AdJr>' CJnu3F �Atlarrtc Beach �r 5a �rhmror aeee evbney Isand_ on St Weymb Pt Nbcon 1 OLD GATE RDYj is S 20 D s��atN �$ w U EATON g ELM O PINE z w Uj z 7q in AB@OTT MORRIS �O� BANKS CRYSTAL OAKS LN EVANS = Cl) � N � SUNSET SITE LOCATION MAY 0 5 2005 Morehead City DCM „v 6RADFORO 60 �MglNr; &CKte&A Fjj h TT S YAUpCN U 011L SS ' "TC6 pig0 1178 � p ol AVFRY � i � tv ARVpv 1178 i F�S�ifR n FUCCHFR t N a = I� r N 1 ~•-" W 70 2 '— 2 ET ti N 70 N '^ "'All �' Q F�+ 4- , rn �y m or' EV N � O 4 r4 PROJECT LOCATION 118 -jr7 O CD CV \ r- ,i; w Q 0 i\ Ln In W co o z � J C O 0 cn IU— J j U w J LLLJLI Of w U clI O BOGUE SOUND i NORTH Ak �✓ — — — — — — — — — — — — — — — — — — — — — — — — — — -= ------------ � COVERED GAZEBO nI1I /-WITH SEATING EXISTING DOCK �'�w 145'-8" EXISTING LIFT TO BE REMOVED EXISTING BOAT LIFT NOTE: 1. EXISTING DOCK 1060 TOTAL SQ. FT. 2. TOTAL L.F. OF SHORE LINE EQUALS 100' OLD ATLANTIC BEACH BRIDGE 3 r APPROX. MEAN LOW a WATER LINE APPROXIMATE RIPARIAN LINE — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4 SCALE. 1 "=15' SMALL MARSH AREA d 0 o N \_ w Q rl7 p N w w cn �a a C;tk G'n - '1i/ z o Q U l.L SANDY BEACH p cn o � o o p z Q � z z O � co p w p Q N F vo KELLY DILDY p 2311 EVANS STREET MOREHEAD CITY, NC Lo W Lo 00 N o cr_ (/7 z z APPROXIMATE J o cn PROPERTY LINE J < 1:1 w Y p Fu O:f N / F No 7MOREHEAD LYNWOOD GRICE 2309 EVANS STREET CITY, NC WEUNIONI ORDER INTEGRATED PAYMENT SYSTEMS INC. • ISSUER Greenwood Village, Colorado 08-292598184 82-40l1021 TIMET13508 040 33 DATE 062505 08292598184b LOCATION 00250142 N iq *,'A** PAY EXACTLY TWO HUNDKII DOLLMS AND NO CENTS PAY EXACTLY PAY TO THE PAYMENT FOFt(ACCT. s: nonco nc rT r--" , -� - PURLHASEfl BY 'You AGREETO THE TERMS ON THERE Western Union Money Order and Design Is a service mark of Western Union Holdings, Inc.rPayable at Wells Fargo Bank Grand Junction - Downtown, NA., Grand Junction, Colorado is t0 2 100I-.001: 4008 29 2 598 184611'