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69099D - Wrightsville
LAMA / DREDGE & FILL i N y js, 11 aENERAL PERMIT Previous permit# A B New —Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued -ized by the State of North Carolina, Department of Environment and Natural Resources :oastal Resources Commission in an area of environmental concern pursuant to 15A NCACy4 ft- p � � El Rules attached. tt Name�i�1VY1 �)1q�t�S} l�� � (.YI Project Location: County iy j Hal It y�y 11 ('M S kaq of ✓ P h1 111001 COWStreet Address/ State Road/ Lot #(s)(rj�{ S� T lq t!4 �b1i�V11u(� State ZIP )q,,^ U Gi} �Y�i1 S��� 11d(k (r0S�I of Aht O)239 111V E-Mail1'�W01IP t �• 0 Subdivision ed Agent I 41 fi 11 1wcfNJUK C14)YL olAqQQcity 1O 1�� Y��/u �2LLich ZIP `JP ❑ CW X EW Nk'Ph PTA ES PTS G• hne # �1T )�V� - �7 / River Basin `� r ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body 4 ❑ PWS: / Closest Maj. Wtr. Body yes /n PNA yes ' Project/ Activity t w�Y kra main firm t rk) length ►tform(s) Platform(s) ier(s) h n r i/ Ri rap length dis a offshore x distan offshore cannel IL sic yards ip se/ Boatlift illdozing \ ;cuff not sure • yes ro ium: n/a yes cccccc{ no J........... _._ .. ....... y no kttached: yes /9 II ,, ,, ig permit may be required by Wl I KA I 1 ^ro1 Plnnnina Inricfiirti . \, xKd Mne sere ice!!//--641 �t,fu of b w, ,a Lt �S V 1 l u Ira to (Scale#T!& L V k P 0 1-7 QYW'l=1�{� See note on ifack regarding River Basin r f I NC Division of Coastal Mgt. Habitat Impact CC. -neuter S3"t Applicant: ` rU AA o& wU Permit* M O cl'j Date., 1,3-( (q Describe. below the HABITAT disturbances for the application foundin your Habitat code sheet. All values should match the name, and units of measurement Habitat blame D1STU RB TYPE Choose One TOTAL Sq. Ft. (Applied for. Disturbance total includes any anticipated restoration or temp impacts) FIN) (A0 did Exc re arr imps C� Dredge ❑ Fill ❑ Both ❑ Other 0 Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge ❑ rill ❑ Both ❑ *Other ❑ Dredge ❑ Fill ❑ Both ❑ Other ❑ Dredge Q Dredge ❑ Fill ❑ Fill ❑ Both ❑ Both ❑ Other ❑ Other El Dredge ❑ Dredge ❑ Dredge ❑ Dredge ❑ Dredge ❑ Dredge ❑ F111 ❑ Fill [( Fill ❑ Fill ❑ Fill ❑ Fill 171 Both ❑ Both ❑ Both ❑ Both ❑ Both ❑ Both ❑ Other ❑ Other ❑ Other ❑ Other ❑ Other ❑ Other 0 1L Sq. Ft, TOTAL Feet for. t,[NfHL renal (Anticipated ;ipated final urbance. (Applied Disturbance disturbance, . ludas any total includes Excludes any and/or ,bration _ any anticipated restoration temp impact Ifortemp restoration or of amount) temp impacts .amount) AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Town of Wriqhtsville Beach Mailing Address: 321 Causewav Dr. Municipal Complex; Town Hall Wriahtsville Beach, NC 28480 Phone Number: 910-239-1770 Email Address: towens towb.orq I certify that I have authorized Highfill Infrastructure Engineering, P.C. , Agent / Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: TWB1701 - NEI ICW Crossing at my property located at DOT right-of-way at S.R. 74 Bridge, Mile 283.1 at Wrightsville,Be2 in New Hanover County. 1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to Division of Coastal Management staff, the Local Permit Officer and their agents to enter on the aforementioned lands in connection with evaluating information related to this permit application. Propert wner Information: signature Print or Type Name Z/ Z/ CERTIFIED MAIL • RETURN RECEIPT REQUESTED RECEI TE: HASE: O SCAN: L717UYPq--^' ❑ COLOR ;HECK: ddldpen ❑ DUPLEX DIVISION OF COASTAL MANAGEMENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Property Owner: Town of Wrightsville Beach APR 0 DISTR bf Property: DOT right-of-way at S.R. 74 Bridge, Mile 283.1 at Wrightsville Beach Agent's Name #: HIGHFILL (Lot or Street #, Street or Road, City & County) Agent's phone #: 919-481-4342 Mailing Address: 2703 Jones Franklin RJOad, Su Cary, NC 27518 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, must be provided with this letter. 41M I have no objections to this proposal. I have objections to this proposal. If you have objections to whatis being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext., Wilmington, NC, 26405-3845. DCM representatives can also be contacted at f910) 796-7215. No response is considered the same as no objection If you have been notified by Certified Mall. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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. i ►�K� I do not wish to waive the 15' setback requirement. (Pr Owner Information) Signat Print or Typd Name 7, /-19 Y �- Z (151 Mailing Address N(- 2 9yg City/Sta te2ip (Adjacent Proptsrty Owner Information) Sign re %ck 6re es Print or Type Name 300 All-sh" ar; vP Mailing Address W;)m;n for pal C o1`6 01 City/Stat ip -ey Ray Spears, Courtney <courtney.spears@ncdenr.gov> Tuesday, April 04, 2017 9:38 AM Jeffrey Ray !ct: RE: TWB1701- NEI ICW Maintenance hments: Adjacent Riparian Property Owner Statement - CM.pdf; agent authorization.pdf; tl5a-07h.1600.pdf f, a recap from our phone conversation — I talked with my manager and she agreed that the probing along the wa with the 1-2" probe would not be considered develop and therefore can be carried out under the previously irized exemption. xcavation of coastal wetlands or public trust area (below normal high water) would need to be permitted throe eneral Permit .1600 for installation of aerial and subaqueous utility lines with attendant structures in coastal nds. To process that general permit I will need the following: An agent authorization form authorizing High Fill to obtain permits on behalf of the Town of Wrightsville Bea Adjacent Riparian Property Owner Notifications (send a map/narrative explaining project to them) — if sent t certified mail, we need the green cards or the certified mail receipts $400 permit fee made payable to NCDEQ attached an agent authorization form, an adjacent property owner notification form, and a copy of the rules fl ral Permit .1600 for your reference. Please let me know if you have any questions. -ega rds, tney Spears Representative an of Coastal Management rtment of Environmental Quality 96 7423 office iey.spears@ncdenr.gov :ardinal Drive Ext. ngton, NC 28405 -'"-''Nothing Compares.,,_ C0 -0 m a N nj .0 Ir 0 0 0 0 0 ra v- E3 a E3 r- ng Number: 70160910000096271368 d Delivery Day: Thursday, April 6, 2017 Q uct & Tracking Information roduct: Features: Certified MajITM Retum Receipt See tracking for related item: Wildlife Resource Commission DELIVERED APRIL 6, 2017 [Q Delivered See Available Actic DATE R TIME STATUS OF ITEM LOCATION B. 2017. 10:35 am Delivered RALEIGH, NC 27699 aneo heel' ree c ^} C a Services & Fees (check box, add leeJyepp rrato Realm Receipt P�copy) $ A" ' _ Rem= Receipt (electrons) $ I ( III I Certifled Meii Restricted Delivery S Adult Signature Required $ $ 0 . 01) Adult Signshm Restricted Delivery S tage $0.49 C1171 C19 John and Eliza Blackwell, LLC Postmark Here DELIVERED APRIL 7, 2017 ll Postage and Fees c CI¢/I-i5 /2C 117 �b . _r9 "—Ain ,n -SIiZti LLC �(�cicwc 1 , e andApE'l�fo or Fsd Hoz f�lo. ' bo r (, NG ';)-7u/ o ) ig Number: 70160910000096271344 d Delivery Day: Friday. April 7. 2017 uct & Tracking Information •oduct: Feattaes: _ a;I = certified Mail' Return Receipt See tracking for related item: 9590940223286225682866 Delivered See Available A( DATE & TIME STATUS OF ITEM LOCATION ', 2017, 10:16 am Delivered, Left with Individual GREENSBORO, NC 27401 .S. Postal Service r r.• ERTIFIED MAIL" RECEIPT omestic Mail Only ] CertUied Mall Restricted DWWM S a U--''' ] Adutt Signature Required t l ] Adutt signature Restricted Delivery $ - Cl9 Postmark Here 04/05/21117 Grand View Holdings, LLC DELIVERED APRIL 7, 2017 'racking Number: 70160910000096271337 Q Delivered in Time ipdated Delivery Day: Friday. April 7. 2017 QQ product & Tracking Information ostal Product: Features: rst-Class Maih Certified Mail"' Return Receipt See tracking for related item: 959OM223286225682859 DATE & TIME STATUS OF ITEM April 7, 2017, 11:03 am Delivered See Available Action LOCATION JACKSONVILLE, NC 28540 April 7, 2017, 8:53 am Available for Pickup JACKSONVILLE. NC 28541 April 7, 2017, 8:52 am Arrived at Unit JACKSONVILLE, NC 28546 April 6, 2017, 7:07 pm Departed USPS Facility FAYETTEVILLE. NC 28302 0 U.S. Postal Servi„ � "' CERTIFIED MAIL° RECEIPT Domestic Mail Only For delivery information, visit our website at tvtvw.usps.com YC.J.- +k') 75 Nra Services & Fees (dock box. add Mlaonraa(a ?te� 60" Rer:elpt Qre -PY) $1I ] Retum Receipt (electronic) $ $1 I . 00 ] C.NMed MeN Restricted DWWWY S i�L,Ti t l ] AduN Signature Required $ 11 A 'A A peel andApt: IVo.; or T� $ox No. li ;-State,I t4s" NC DOT DELIVERED APRIL 7, 2017 ;ing Number: 70160910000096271351 �Q Delivered ted Delivery Day. Friday. April 7. 2017 suet & Tracking Information See Available Ai Product: Features: Certified MailTA Return Receipt See tracking for related item: 9590940223286225682873 DATE & TIME STATUS OF ITEM LOCATION 17, 2017, 11:01 am Delivered, Left with Individual WILMINGTON, NC 28401 HIGHFILL 2703 Jones Franklin Road, Suite 201 INFRASTRUCTURE Cary, North Carolina 27518 ENGINEERING, P.C. Tel 919-481-4342 Fax 919-882-9762 April 5, 2017 RE: Notice of Surveying and Data Collection Town of Wrightsville Beach NEI ICW Crossing Project Dear Property Owner: You are receiving this package via Certified mail to comply with DENR regulations. It was brought to our attention that Priority mail is not an approved method of delivery. The contents of this package are the same as what you've previously received with exception of this notice. If you have any questions or need any additional information, please feel free to contact me, Jeffrey Ray, at 919-481-4342 orjray@hiepc.com. Thank you in advance for your cooperation in this matter. Sincerely, HIGHFILL INFRASTRUCTURE ENGINEERING, P.C. i 4k--(g 7T�K Jeffrey Ray, EIT Engineering Support Specialist enclosures cc: Tim Owens, Town Manager, Town of Wrightsville Beach H I G H F I L L 2703 Jones Franklin Road, Suite 201 INFRASTRUCTURE Cary, North Carolina 27518 ENGINEERING, P.C. Tel 919-481-4342 Fax 919-882-9762 April 5, 2017 RE: Notice of Surveying and Data Collection Town of Wrightsville Beach NEI ICW Crossing Project Dear Property Owner: The Town of Wrightsville Beach has identified the sanity sewer force main that crosses the intercostal waterway as critical infrastructure that requires inspection. The inspection will provide important information on the current condition of the force main, as well as future service ability for the Town of Wrightsville Beach. To complete this condition assessment, Highfll Infrastructure Engineering, P.C., or their sub -consultants, may need to be on your property or adjacent property for surveying and data collection. The purpose of this letter is to inform you of the proposed work and to request your cooperation in allowing us on your property to perform the surveying and data collection. Please sign and return the enclosed form, via mail or email, which grants Town of Wrightsville Beach and/or its agents permission to access your property. If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writing within 10 days of receipt of this notice; however, by signing the attached access permission form, you can help expedite this time -sensitive project. All individuals entering your property are instructed to protect all property that they come in contact with. Each person will have identification with them. If you have any questions or need any additional information, please feel free to contact me, Jeffrey Ray, at 919-481-4342 orjray@hiepc.com. Thank you in advance for your cooperation in this matter. Sincerely, HIGHFILL INFRASTRUCTURE ENGINEERING, P.C. Jeffrey Ray, rIT Engineering Support Specialist CERTIFIED MAIL • RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM Name of Property Owner: Town of Wrightsville Beach Address of Property: DOT right-of-way at S.R. 74 Bridge, Mile 283.1 at Wrightsville Beach (Lot or Street #, Street or Road, City & County) Agent's Name #: HIGHFILL Agent's phone #: 919-481-4342 Mailing Address: 2703 Jones Franklin Road, Sui Cary, NC 27518 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 must be provided with this letter. I have no objections to this proposal. I have objections to this proposal. If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) In writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext, Wilmington, NC, 26405-3845. DCM representatives can also be contacted at (910) 796-7215, No response is considered the same as no obiection if you have been notified by Certified Mail, WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin 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. I do not wish to waive the 15' setback requirement. (Pr Owner Information) Signatt Print or Typd Name 7/10Y �-2(1: Mailing Address City/State/Zip (Adjacent Property Owner Information) Signature Print or Type Name Mailing Address City/state/Zip E -:nHF Fti R r }• gk RC1AO CENTERLINam ES �..�G F{E — OHE lid OHE —„ OHE�- �— OHE ___ �OHE — OpE �yy� pONE �--: Bt'IE _ OHE'—. ORE -C OHE ov 4 ti , F T h;. POWERLI ES i 0oc �' r 00, _ CAMA PERMIT - LAYOUT MAP TWB1701 - NEI ICW CROSSING TOWN OF WRIGHTSVILLE BEACH N;� ulr-up,ii I HIGHFILL INFRASTRUCTURE ENGINEERING, P.C. To: Courtney Spears Copies: Field Representative Division of Coastal Management 127 Cardinal Drive Ext. Wilmington, NC 28405 Date: April 13, 2017 From: Jeffrey Ray Subject: CAMA Permit Proj. No.: WE ARE SENDING YOU: ® Attached ❑ Shop Drawings ❑ Samples TRANSMITTAL 2703 Jones Franklin Road, Suite 201 Cary, North Carolina 27518 Tel 919-481-4342 Fax 919-882-9762 (via email) Timothy W. Owens, AICP Town Manager 321 Causeway Drive Wrightsville Beach, NC 28480 TWB 1701 COPIES DATE NO. DESCRIPTION 4 USPS Certified Mail Tracking Information w/ Certified Mail Receipt and 3 Green Cards. 1 Copy of Notification Letter with Map sent by Certified Mail on April 5, 2017 1 11x17 Layout Ma 1 Check of 400 made to NCDEQ (Will be Muj I ) COMMENTS: Hand delivered on site in the field to Courtney Spears. TRANSMITTAL H I G H F I L L 2703 Jones Franklin Road, Suite 201 INFRASTRUCTURE Cary, North Carolina 27518 ENGINEERING. P.C. Tel 919-481-4342 Fax 919-882-9762 To: Courtney Spears DEQ, Division of Coastal Management 127 Cardinal Drive Ext. Wilmington, NC 28405 Date: April 13, 2017 From: Jeffrey Ray Subject: CAMA Permit Copies: (via email) Timothy W. Owens, AICP Town Manager 321 Causeway Drive Wrightsville Beach, NC 28480 Proj. No.: TWB 1701 WE ARE SENDING YOU: ❑ Attached ❑ Shop Drawings ❑ Samples COPIES DATE NO. DESCRIPTION 1 Check of 400 made to NCDE for CAMA Per ' COMMENTS: ■ Complete itenii; 1 '2, and 3. ■ Print ydiat hed`r"r.�g,and address on the reverse Sot t ' a cao_ urn the card to you. ■ Attach this Ltd -ttle back of the mailpiece, or on the FFont'#,space permits. 1. Article Addressed to: fro 13�> oo �<.G%SOy.vr/t" NG, v*S 1111111111111111111111111111111111111111111111 9590 9402 2328 6225 6828 59 2. Article Number (Transfer from service label) 70/(p 0q/v 0L PS Form 3811, July 2015 PSN 7530-02-000-9053 ■ Compl6 e items 1, 2, and 3. ■ Print'yoT name and address on the reverse so thatvlee 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: s-i5 h► , /UCH 3LE3 C/U I- i I IIIII III III i IIIII I I III II II II I II II II III 9590 9402 2328 6225 6828 73 2. Article Number (Transfer from service label) 701(o ©qua (9000 9&2-7l PS Form 3811, July 2015 PSN 7530-02-000-9053 A: Si natu rl _ Agent Addressee X `�� �' /� ❑ Addressee eceived by (Printe N e) C. D to f Delivery \L 4K, L.: b1 �7r 1; q D. Is delivery address differenttFrom item 14 U Yes If YES, enter delivery address below: ❑ No 3. Service Type ❑ Priority Mail Express® ❑ Adult Signature ❑ Registered Mail - El Adult Signature Restricted Delivery ❑ Registered Mail Restricted ❑ Certified MZO Delivery ❑ Certified Mail Restricted Delivery ❑ Return Receipt for ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery EI Signature Confirmation- Ir"7redL.L4 l Restricted Delivery $5 ) ❑ Signature Confirmation Restricted Delivery Domestic Return Receipt A. Sign re X ®'Agent d' El Addressee B. R ived by (Pr' ted N m) C. Date of Delivery w L4 -n --I D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 0. Jervice lype ❑ Adult Signature 0 Adult Signature Restricted Delivery ❑ Certified MailO ❑ Certified Mail Restricted Delivery ❑ Collect on Delivery ❑ Collect on Delivery Restricted Delivery ❑ Priority Mail Express@ ❑ Registered Mail- ❑ Registered Mail Restricted Delivery ❑ Return Receipt for Merchandise ❑ Signature Confirmation - Ins ail ❑ Signature Confirmation I ur ail Restricted Delivery ") Restricted Delivery Domestic Return Receipt ■ Complete items 1, 2, and 3. A. Signature / ■ Print your name and address on the reverse rB.Receiv4 � ❑ Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, by (Printed Name) C. Date of Delivery or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 17 ❑ Yes If YES, enter delivery address below: ❑ No �3o Su- 17-� o�15UD Nc- y o/ II I IIII�I IIII ICI I (IIII II III II I I II II I I I'lll III 3 Service T 9590 9402 2328 6225 6828 66 2. Article Number (Transfer from service label) 70/6 0 9/n 000D 96 �- PS Form 381 1, July 2015 PSN 7530-02-000-9053 Domestic Only ..0 minformation, r For 2 - r~ rU Certified Mail Fee ¢ 5 —0 $ $ J . �.! _� ]C Cr Ex Services &Fees (check box, add tee I . I Ire) O Retum Receipt (hardoopy $ E3 Retum Receipt (electronic) $ $0 III 1 Q ❑ Certified Mail Restricted Delivery $ d ICI i i,�l C3 ❑ Adult Signature Required $ ❑ Adult Signature Restricted Delivery $ p Postage ra $ $0.49 Cr Total Postage and Fees $ $6.59 raj Sent To t) % `d / O Street and Apt. 4/0., or P f� �D 0,ck, Type ❑ Adult Signature ❑Priority Mail Express® ❑ Adult Signature Restricted Delivery El Registered MaiIT^' El Registered Mail Restricted ❑ Certified Mails Delivery ❑ Certified Mail Restricted Delivery El Return Receipt for ❑ Collect on Delivery Merchandise ❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmationrm '� uJy�9 I ❑ Signature Confirmation �1'. M1cdl`e it Restricted Delivery $5 ) Restricted Delivery u9 Postmark Here i 14/U5/?i 117 1-e t v ou," C c, �c+ ran S S i v7 -- --------------------------- b �/ox No. c�- �Qn �c� - ----------------------- ------------------------ Domestic Return Receipt Domestic 'I For delivery information, visit our website at www--sP--1COm-.- o Certified Mail Fee $�35 �. ,. 1171 $ - 119 E�a Services 8 Fees (check box, add lee ps,9opRpr�;.te) Retum Receipt (hardcopy) $- 1-I.0 Ci � 3 Return Receipt (electronic) $ - ❑ Certified Mail Restricted Delivery $ Sri . fir] Postmark Here ] ❑ Adult Signature Required $ GI_ 1�1111_ ❑Adult Signature Restricted Delivery $ � Postage $ 04/05/2017 Total Postage and F �bs 3 ..r9 Sent To 1 v14-0 T/y/T r ' S aPt ---- p-- o� %Q ----- -------------------------------------- City, State, Z,rp+4• A //�� c� �y /' Postal CERTIFIED o RECEIPT -2 Domestic Mail Only M r GREENSBC1RO-f NC 2 7 41J' Pills fl.l _nC ertfied Mail $3.35 01 Er $ E# a Services &Fees (check box, edd lee �pptVpnate/ �Jie75 r 0 tum Receipt (hardcoPY) $ , =r?' ❑ Return Receipt (electronic) $ 11 111 I (:3 ❑Certified Mail Restricted Delivery $ $Cl f j`(_ Postmar Here 0 El Adult Signature Required O ❑Adult Signature Restricted Delivery $ Postage $1i.49 a Er C3 � $ i14/05/2>_�] Total Postage and Fees $a.59 $ o Sent To ,)4)n 4 si'Zti �ckt..c l� Lit- ____ t �. Of PYd-1w ___ __ _______________________ , criy ------- - �u'*��------aOc te,Z1R;d-- sl�oso. Ili .)'7L1n1 Postalic CERTIFIED MAILWEIPT Ln Domestic Mail Only M f1J Certifed Mail Fee �c $ �"` -n _r $ i1171 Q^ ry 7C Extra Services 8 Fees (check box, edtl lee �PCgprjete) Peturn Receipt (hardcopy) I 1-19 O O $1. , ❑ Return Receipt (electronic) $ I I -11 1 E3 ❑ Certified Mail Restricted Delivery $ ' 1 i 1 I 0 Postmark Here ❑Adult Signature Required $ ___l•___ ❑ Adult Signature Restricted Delivery $ O a Postage $H.49 Er Cj $ Total Postage and F"a 114 ' 1! =1 $ $c..t9 �Sent To t C K � t �S 1:3or N Srieei anif apt. ivo., Pa$oz No: ------------------ nQ e.�i-. " uC1% ✓ t / w--------'-l.� ,Mere, a+ ry_ -------- A-s-,,r, " - - —'?I� t1r)