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39052D - Lewis
CAMA/ ❑DREDGE & FILL 3ENERAL PERMIT Previous permit# :New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued rized by the State of North Carolina,Department of Environment and Natural Resources :oastal Resources Commission in an area of environmental concern pursuant to ISA NCAC /// /_ [Rules attached. it Name s'Cc !C( C C.U' :> Project Location: County i.< <f r /5 Lc)/C k 970 -iO3 Soc -frr74-.31,y2 1: /eUed Street Address/State Road/Lot#(s) /CS :, r,',j, : State WC. ZIP ..;iy(a I JGv`t-C I i /jci i ; 1 c f-f / (j/0) 2/.6t1 03© S Fax#( ) Subdivision :ed Agent 64 t,-c (..,ii../ u- i-f [is City - He) fc%i7 ",C,C,C i ZIP ,,,?a''4'- 0 CW $EEW Xl PTA ❑ES ❑PTS Phone# ( ) River Basin I. r. . ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (nat ❑ PWS: ❑FC: �C/�'7lc. yes / no PNA yes /(fio) Crit.Hab. yes / no Closest Maj.Wtr. Body `� �' f Project/Activity i) • h1 i c/ ' /-) (Scale: / - )ck)length 4'111_11_ i angth I \ .' , , } ! ! ember + * M CA NA L.,ad/Riprap length ,._ 1 1 fg distance offshore i-_ _-- __....-- lax distance offshore _ - -}-� _._ .T._ i ' _l-..... — -F flannel ,.. / { 1I t 1 - -- t _jir_:_ _ ___ _ i __ __ -- Jbic yards - C-c-• ._ .mp — — F use/Boatlift } I -L--: . Bulldozing 15 1 ii { '� ' — — r / - I i P-a ...e_/I, - {_- :. _ —_ ne Length r — _ -_ .. .. . .._...... �___ " r not sure yes no t P L • I- i rt { cgs: not sure yes no Ti j - 1I rrium: n/a yes no 1 I — . yes no ,.._ i a._! 1 =-I— a +- Attached: yes no' I i , i I r` ling permit may be required by: ' ' <r C i . . I See note on back regarding River Basin GENERAL PERMIT COMPUTER FORM 'PLICANT NAME: ( rc p u7 lS )DITIONAL NAMES: iC DESIG: E) 1 DEVELOP AREA. .b (_ PROJ DESC:P -k ll only take 6) (Will only take 1) DRK: `7-E , ►y- 23 - 11 only take 4) fs t 1 4- HINT: 1]only take 4) T: OW Z Z1-1- 1 only take 6) ACTION EXPIRATION LEDGE&FILL REQUIRED: /(7/61 `l 7/0 ' LMA MAJOR DEVEL REQUIRED: 74 y 70 Z SECTION.1200-GENERAL PERMIT FOR CONSTRUCTION OF PIERS: DOCKS: AND BOAT HOUSES ESTUARINE AND PUBLIC TRUST WATERS AND OCEAN HAZARD AREAS 15A NCAC 07H.1201 PURPOSE A permit under this Section shall allow the construction of new piers,docks,and boat houses in the estuarine and public waters AECs and construction of new piers and docks within coastal wetlands AECs according to the authority provide Subchapter 07J.1100 and according to the Rules in this Section. This permit shall not apply to oceanfront shorelines waters and shorelines adjacent to the Ocean Hazard AEC with the exception of those shorelines that feature characteristi the Estuarine Shoreline AEC. Such features include the presence of wetland vegetation, lower wave energy, and 1( 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 I, 1984; Amended Eff April I, 2003. 15A NCAC 07H.1202 APPROVAL PROCEDURES (a) The applicant must contact the Division of Coastal Management and complete an application form requesting approve development. The applicant shall provide information on site location, dimensions of the project area, and his name address. (b) The applicant must provide: (1) confirmation that a written statement has been obtained signed by the adjacent riparian property ow indicating that they have no objections to the proposed work;or• (2) confirmation that the adjacent riparian property owners have been notified by certified mail of the propi work. Such notice shall instruct adjacent property owners to provide any comments on the prop( development in writing for consideration by permitting officials to the Division of Coastal Manager. within 10 days of receipt of the notice,and, indicate that no response will be interpreted as no object DCM staff shall review all comments and determine,based on their relevance to the potential impac the proposed project,if the proposed project can be approved by a General Permit. If DCM staff finds the comments are worthy of more in-depth review,the applicant shall be notified that he must subm application for a major development permit. (c) Approval of individual projects shall be acknowledged in writing by the Division of Coastal Management and applicant shall be provided a copy of this Section. (d) Construction 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 Coz 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 Departm 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 F.fT Aumrct 1 7nnn• 001 • (b) Individuals shall allow authorized representatives of the Department of Environment and Natural Resources t periodic inspections at any time deemed necessary in order to be sure that the activity being performed under the auth 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 o docks and boat houses. (d) This permit will not be applicable to proposed construction where the Department believes that the proposed i might unnecessarily endanger adjoining properties;significantly affect historic,cultural,scenic,conservation or rec values, identified in G.S. 113A-102 and G.S. 113A-113(b)(4),nor that might significantly affect the quality of the 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 lot 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 1, 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 norm2 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 simil This restriction shall not apply to piers 100 feet or Iess in length unless necessary to avoid unreasonable interferenc navigation or other uses of the waters by the public such as blocking established navigation routes or interfering with acc adjoining properties. The length of piers shall be measured from the waterward edge of any wetlands that border the body. ' (c) Piers Ionger than 200 feet shall be permitted only if the proposed length gives access to deeper water at a rate of a one foot at each 100 foot increment of pier length longer than 200 feet,or if the additional length is necessary to span obstruction to navigation. Measurements to determine pier lengths shall be made from the waterward edge of any c 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 sul 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 sh 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 sh 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 exc combined total area of 400 square feet. The combined total area for lots less than 100 feet shall not exceed four squar per Iinear 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),(f),(g)and(h)of this Rule shall not apply to pier structu existence on or before July 1,2001 when structural modifications are needed to prevent or minimize orm damage. In cases,pilings and cross bracing may be used to provide structural support as long as they do not extend more than of tw on either side of the principal structure. These modifications may not be used to expand the floor decking of platform piers. (j) Boathouses shall not exceed 400 square feat anti ei,nil i,.,..e g 09 04 04; 48p Rae Pc 19102512208 p. 1 RIGHT ANGLE ENGINEERING,PC FACSIMILE TRANSMITTAL SHEET TO: FROM: Caroline Bellis Shane Lippard COMPANY: DATE: GairigpolimBlek AL: 1) eH 8-C9-04 FAX NUMBER TOTAL NO. OF PAGES INCLUDING COVER 395-3964 3 RE: SENDER'S REFERENCE NUMBER: Craig Lewis Dock Permit NOTE S/COMMENTS: Caroline, Attached is Dock Plan for the Craig Lewis Site at Scotch Bonnet Road in Holden Beach. We have sent out the required adjacent property owners notification, but have not received the waiver of 15' setback for the boat lift. The Applicant/Owner wishes to delete the boat lift and just proceed with construction of the pier/dock. PIease call at your earliest convenience to schedule the site visit. , Shane ipp Right Angl gineering Cc: Craig Lewis,Owner/Applicant g 09 04 04: 48p • Rae Pc 19102512208 p. 2 iiE- ' $t' 0 r 8 • I O � a P g c 0 IPF ocEoi N1Ew elk-w. I . ATLANTIC OCEAN Iof alVICINITY MAP - NOT TO SCAT z :J = NOTES: w l 1. THIS SURVEY IS OF AN EXISTING PARCEL OF LAND. r` 0 2. ALL DISTANCES ARE HORIZONTAL GROUND UNLESS 54 OTHERWISE NOTED. p 3. SURVEY DEPICTS EVIDENCE FOUND IN FIELD. WOOD SPLIT 4. NOT PREPARED FOR RECORDATION AS PER RAIL FENCE Z GS 47-30 AS AMENDED. EB. IRS 5. THIS PROPERTY IS LOCATED IN FLOOD ZONE VE 17 i` �,, AS SCALED FROM FLOOD INSURANCE RATE MAP EB i 3 COMMUNITY PANEL NUMBER 375352 0010 E ' SEPTIC CPtx DATED APRIL 2, 1991. TANK 6. ALL ELEVATIONS ARE BASED ON MEAN SEA LEVEL I 0 (MSL) DATUM NAD 83 FROM NCGS MONUMENT x `o STAMPED "HIGH'. ELEVATION = 6.12' r` Lo LEGEND p IPF IRON PIPE FOUND 0 IRF IRON REBAR FOUND x Lrl i'' IRS IRON REBAR SET w CP CABLE PEDESTAL WOOD SPIT p Z TP TELEPHONE PEDESTAL RAIL FENCE\ 0 LB ELECTRIC BOX 7.8 SPOT ELEVATION x 5 I R/W RIGHT OF WAY z r- 0 0 LOT 157/158 HERITAGE HARBOR cn D.B. 1389, PG. 631: P.B. 9, PG. 87 x �� BRUNSWICK COUNTY REGISTRY. JT RAIL KENCE X_J -r a 43.78 IRF ^ TBM IS A PK NAIL f gi SET ELEV IN5.79 C/L' ROAD = z 3 Note: Elevations shown are W N referenced MSL. MLW for this area F= N is -3.1 MSL. to SCALE : 1" = 20' cc0 20 40 IPF AT RIGHT-OF-WAY INTERSECTION BONNET DRIVE CNDCOTCH PROPOSED DOCK PLAN OCEAN VIEW BLVD. >c+nn ran A Tr T T1 TAT Co 19102512208 P• 3 g 09 04 04:: 48p • Rae Pc f 0— 2/- i! 6 v 1 I i ,.. 5 1 , 7,..,..„.„.„ :,....„...„ !.:-...,,iF.5".:-... ?•:"•":T-) _ $ •-wies Z1 I < •i 0 1::, , .... .—....__ ... ..—. ..— .. ... N 8847.01 ' RIPARIAN— F...-____ eV 2 10 Oa 1.......L...i I r - - - - -- - - - - . . , .1 2 •,, 1 0 r< -m1 •- I< 10 1.7:43. \ o 0 4J la J 2 / • 0 .,,, PROPOSED • §/ S . 'R ID HOUSE 70:2S / • / / • / \ . — L . / NORMAL. HIG11-0...- . . • / WATER 2 r '': -. -----x x X — N• _. .IR F 48.22 S -87.07 rn'22 IN WOOD BULKHEAD :: '! . ,.: i ._:, 2,..!::::.:',. ..:,.'•-: '" ......-.....:...".:.z....7:-......;.:;::::: :t. .•.-.-...7.: -1 1 • i I ' ; V:, 7 04 10: 29a • Rae Pc 19102512208 p. 1 Iff4(44'-t . (2-Pr"- C., r_,<,g 4- zs i - `{4 4 u g oI J Q c n 2 Z iu u Q c� _ �� — N.88'47 RIPARIAN IRS& F+--kg --Om-, ilY r -- = 7 Z *P -or _ <8 §-I ;a l' 00 Ii Win 2 fii r . \ d r PROPOSED _: / if y� Q_ri` OOd\^ 3 m // 87.0' • - - • O / in L n NORMAL HIGTi —a WATER \ '�^_ 19 ' x x� —X °, — oY3 °�oYYd IRF 48.22 SST W000 BULKHEAD • • I I I ' I . I I 9 04 04: 10p ' TOWN OF HOLDEN BEACH 9108429315 p. 1 r�o�W*1 IIII lete,pt, PLANNING & INSPECTIONS DEPARTMENT PLEASE CALL ME AND VERIFY THAT YOU HAVE RECEIVED THIS FAX. AN ihau.com ORIGINAL TO A SCALE SURVEY IN THE MAIL!'111I 11l I I t I r l t .pector vnhall,corn inistrator Urgent high importance" " m m 3II.com June 29, 2004 TO: Caroline Bellis FROM: Rhonda Phillips A COPY OF A SURVEY AND A WAIVER FORM FROM THE ADJACENT PROPERTY OWNER WAS DROPPED BY AT TOWN HALL TODAY. THE OWNER CRAIG LEWIS OF 105 SCOTCH BONNETT IS APPLYING FOR THIS PERMIT. I WANTED TO LET YOU KNOW THAT I DO NOT FEEL THAT THE RIPARIAN LINES THAT ARE BEING SHOWN ON THIS PLAT ARE CORRENT. THESE LINES CANNOT BE CORRECT WITH THE LOT BEING LOCATED AT THE END OF A CANAL. PLEASE MAKE SURE THAT THIS IS CLOSELY LOOKED AT BEFORE ANY PERMITS ARE WRITTEN. THERE IS KNOW WAY THAT THIS IS CORRECT BECAUSE THE LOTS AT THE END OF THE CANAL WOULD HAVE NO RIPARIAN RIGHTS. 9 04 04: 1Op TOWN OF HOLDEN BEACH 9108429315 p. 2 DIV"ISIONN OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM Name of Individual Applying For Permit: Craig Lewis Address of Property: 105 Scotch Bonnet Drive, Holden Beach (Lot or Street 14, Street or Road) Brunswick County (City and County) I hereby certify that I own property adjacent to the above-referenced property. The individ applying for this permit has described to me as shown on the attached drawing the development ti are proposing. A description or drawing, with dimensions, should be provided with this letter. I have no objections to this proposal. A++It j e rc(r iz If you have objections to what is being proposed, please write the Division of Coas Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39 within 10 days of receipt of this notice. No response is considered the same as no objectioi you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must set bck a minimum distance of 15'from my area of riparian access-unless waived by me. 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. r - -! 1�,F cL �o� - 6 i- Sig ame Date 9 04 04: 10p ' TOWN OF HOLDEN BEACH 9108429315 P• 3 .x. -,4- ,,... od M/el .09 3A180 13NN08 HaLOOS ars• °(L.' z II =0 cc- cgl. > 0.7-.• 0 la.1 co LIJ J LO I-- 1-V)UJ 1- 0 UJZ <CEZQ P4ZUJ ] „617,0 .1.0 N De L.9.0g 3 .,00,i1.1.0 N , • -• - 6L.(16 M „LZ,ZZ.1.0 S±)-- K m 0 . - -r- NI1 311 -FA7?:I i61-7=1 X ...._X-------A,-1=X X--\ 3N11 311 M/8 i CC ( \ I< 7 ca • -.. 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OCEAN NEW BLw• 'NES1 ru.�.-UMW.e IN i5 sss sfl sa L5+7 s+s 5 I g 10 B t2 R u , . -- Ib•veal-a-r.n :.0 .y2 1 772 1p 15+ . 26 R_2 8♦ - 8 — ,• . •• u ,,, y71 bf9 555 772 12F• 10 6.� — .�• su ;,ly sel y�n I s» 575 172826li:su . R 22 8 2 - 1{ sv "• e• _ , sn I �7 I s•f i 9 32 3 30 a 2E 0�� ., n sa..� 1 �..00 o o� s IS— p 1 • d. a — { w @+0 •re s�'L'oa ,o so I o—L.i fo ��._._.— '-iV so no •- ' f9 s�so y 7 8 9` 13 17 17 C t9 -21 '23 15 t� 11 k I_ !0 1 1 11 •_ If1 • L— ._ , -...fu_t_� 17.1+ .o-�7f`,-T ..I,� - 5 -)^ .1-✓�B•1 .a}_ - t =��+�� p` CI `QQ � 1 . • • rtfl U . IIII Ci PLANNING & INSPECTIONS DEPARTMENT alker PLEASE CALL ME AND VERIFY THAT YOU HAVE RECEIVED THIS FAX. AN btownhall.com ORIGINAL TO A SCALE SURVEY IN THE MAILI I I I I II I I I I I I I I I I it Inspector 'hillips Ihbtownhall.com Aandministrator Urgent high importance" n ownhall.com June 29, 2004 TO: Caroline Bellis FROM: Rhonda Phillips A COPY OF A SURVEY AND A WAIVER FORM FROM THE ADJACENT PROPERTY OWNER WAS DROPPED BY AT TOWN HALL TODAY. THE OWNER CRAIG LEWIS OF 105 SCOTCH BONNETT IS APPLYING FOR THIS PERMIT. I WANTED TO LET YOU KNOW THAT I DO NOT FEEL THAT THE RIPARIAN LINES THAT ARE BEING SHOWN ON THIS PLAT ARE CORRENT. THESE LINES CANNOT BE CORRECT WITH THE LOT BEING LOCATED AT THE END OF A CANAL. PLEASE MAKE SURE THAT THIS IS CLOSELY LOOKED AT BEFORE ANY PERMITS ARE WRITTEN. THERE IS KNOW WAY THAT THIS IS CORRECT BECAUSE THE LOTS AT THE END OF THE CANAL WOULD HAVE NO RIPARIAN RIGHTS. DIVISION OF COASTAL MANAGEMENT • ADJACENT RIPARIAN PROPERTY OVv`NER NOTIFICATION/WAIVER FORI\! Name of Individual Applying For Permit: Craig Lewis Address of Property: 105 Scotch Bonnet Drive, Holden Beach (Lot or Street#, Street or Road) Brunswick County (City and County) I hereby certify that I own property adjacent to the above-referenced_property.e The indi, P applying for this permit has described to me as shown on the attached drawing the developmer are proposing. A description or drawing, with dimensions, should be provided with this let I have no objections to this proposal. nn ri If you have objections to what is being proposed, please write the D visi IIa rCb of Cc Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-39 within 10 days of receipt of this notice. No response is considered the same as no object you have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift my set bck a minimum distance of 15' from my area of riparian access-unless waived by ml 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. Si ame `� Date • L 0 T 1 5'.'";.; cr, , !• I ch Y ., '03 .:_ic ci /.,..1.. j .:7,WERI....i.- A;z:7. ;• <0 , .0 i •-cirn :.1 , WOOD SPUT ‘0 - RAIL FENCE Z _ RI IAN - o 4115 N 88.47'00ft W 100738 IR1 \___E±D TP1RS x 0 F".•----— P.le< --1....- EB • M in r — --,SEPTIC CP -........ la lo r . L_ TANK CC H ---L.--I 1 : 0 _i_ -_ ----"...... t Xf -0 (CI (10 , : r, 1 in ; La t r-- - ' ...r F 0 N 1M z°-,, -t In _.I I in Fr w.- w F — ' a mIS) Tc : -:tm 0 PROPOSED HOUSE WOOD SPUT i z 0 0 - hi Q '0 0 CD Z 1,71:745. 0 rr) 87.0' m (..) ••••., ,Z 0 - . 0 (I) , X In INOt Z 7... 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ZO .-. yD 5° JaD 80 �s�D � 2:21 -23 ^25 314` 0 s0 S0 ^�... _/"/_ - --(a--,1 .1 50 a1-3 �15 °,7 9 `� • • [P OfficeJet K Series K80 Log for ersonal Printer/Fax/Copier/Scanner TOWN OF HOLDEN BEACH 9108429315 Jun 29 2004 4:11pm ast Transaction ate Time Type Identification Duration Pages Result in 29 4:09pm Fax Sent 3502004 1:35 4 OK SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY • Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. 0 Agent • Print your name and address on the reverse X 0 Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delive ■ Attach this card to the back of the mailpiece, iece, CC __ II or on the front if space permits. RP�r�L'c oe Jam-./(A (1i 2 22 CC D. Is delivery address different from item 1? 0 Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No 44* &nk,,5.cAti/z, 20/ foxcxe„ 3. Se ce Type �/► Certified Mail 0 Express Mail /77)4/7 / �7 0 Of ❑ Registered 0 Return Receipt for Merchandise ❑ Insured Mail 0 C.O.D. 4. Restricted Delivery?(Extra Fee) 0 Yes 2. Article Number 7004 1350 0001 8376 8852 (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY • Complete items 1,2,and 3.Also complete A. Sign/re item 4 if Restricted Delivery is desired. ' 0 Agent • Print your name and address on the reverse X/4 0 Addressee so that we can return the card to you. -O. R eiv=Eby(Printed Na e) C. Date of Delivery • Attach this card to the back of the mailpiece, e or on the front if space permits. D. Is delivery address different from item 1? 0 Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No eeiri � 6k/174 %doQ/ / eCG L26.30 `�'—O �' 3. Servic SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVER ,a _ .a • Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. • Print your name and address on the reverse X , 40:kt IA y om so that we can return the card to you. B. Received by(Printed Name �'C. D o i • Attach this card to the back of the mailpiece, Vi 1 �Of1 N ^ ' i d. or on the front if space permits. )Y I iL< Q D. Is deliv ry address different from' m 1? co U 1. Article Addressed to: If YES,enter delivery address below: a 5 ) p/R4-15 /-17-7- 7. 1 \\,.......:41,., j w 65 3. Se e Type N. Certified Mail ❑ Express Mail ❑Registered 0 Return Receipt fa ' C.) AI/C/0. 0( /17 / ;gVj_� : ❑Insured Mail 0 C.O.D. l� 4. Restricted Delivery?(Extra Fee) w Q ( 2. Article Number 7004 1350 0001 8376 8869 0 (Transfer from service label) � PS Form 3811,February 2004 Domestic Return Receipt • t n � ; ru C SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY Et • Complete items 1,2,and 3.Also complete A. Sign- . - I C item 4 if Restricted Delivery is desired. rl ■ Print your name and address on the reverse X /�r.j/L. ,/� It' 1 so that we can return the card to you. B. R. eived by(Printed -. e) C. Da 0 • Attach this card to the back of the mailpiece, 1 9; J P� -+ or on the front if space permits.c A. I,' �I ,ii�s�l� ' rt D. Is delivery address different from item 1? I 1. Article Addressed to: If YES,enter delivery address below: I 1 C 1,#/lits- 1 rd6ffe � 0 Q u C1� ,�-� n o v I/6 S 140/7anr-11/1G 3. Servic e 1 ! vy%/C ertified Mail ❑Express Mail agiye / �83& . ❑ Registered 0 Return Receipt for ❑Insured Mail 0 C.O.D. I . '... Ct 4. Restricted Delivery?(Extra Fee) f _ 0 z a, C2. Article Number 0 �g " C (Transfer from service label) 7004 1350 0001 8376 8838 x m PS Form 3811, February 2004 Domestic Return Receipt to