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HomeMy WebLinkAboutTown of Emerald Isle 76660C/- AAMA / DREDGE & FILL LreerueRal PERMIT lllll - 'N.r, Modification Complete Reissue Partial Reissue As authorized by the State of North Carolina, Department of Environmental Qudity and the Coastal Resources Commission in an area of environmenlal concern pursuant to l5A NCAC Previous permit # o "(:D Date previous perm Rules anached. Project Location: Counry it issued ZApplicant Name Address City State Phone#( ) _ E-Mait ztP Authorized Agent Afiected t-l cw Ciq/ ZIP Phone# ( ) - - RiverBasin Subdivision Adj. Wtr. Body I " / l6at /man /unkn)' Closest Mai. Wtr. Bo4, i _r Ew T HHF f] PTA I] IH >E€F tr UBAAEC(s): u oEA . , t] PWS: ORW: yes / no PNA yes / no Type of Prolecv ActiYity (Scale /7 ) Pier (dock) l€Bth / - Floating Platform(s) Finger pier(s) Groin length number Butkhead/ Riprap length ay8 distence ofishore : max drsence ofi3(orc i I 7 I H w M41) + --l t Beach Bulldozint @rer ++ffi l--+ -tShoreline Len$h ) SAV: not stire yes no Moratoriumr nla lll L I A buildinS permit may be required by ( Note Local Planning lurisdiction) E See note on back regarding River Basin rules tt Notes/ Special Conditions ASent or Applicant Printed Name SEnature * Please read compliance statement on back of permit * PermatOfficer's Printed Name SiSnature u,I Appli.etion Fee(s)Check#r..rin! Outu E xpiration Date Street Addresy SFte Road/ Lof#(s)_ ! PTS tr rva Fixed Platform(s) E-i-+-#-+ ffi ltt !Ll LL,l +-1-t++-+-- j-+-H &sin, channd / tI 1 cutic virds I It,Ba remo I I Boathoure/ Boadift L I ---1+,ty1fit1+Fdi+,F: I -H-t- *-t'1 lt I l ll Statement of Compliance and Consistency This permit is subiect to compliance with this application, site drawing and attached general and specific conditions. Any violation of these terms may subiect the permittee to a fine or criminal or civil action; and may cause the permit to become nulland void. This permit must be on the project site and accessible tothe permit officer when the proiect is inspected forcompliance. The applicant certifies by signing this permit that l) prior to undertaking any activities authorized by this permit, the applicant will confer with appropriate local authorities to confirm that this proiect 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 adiacent 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, certirythatthis proiect is consistent with the North Carolina Coastal Management Prograrn. River Basin Rules Applicable To Your Project: Tar - PamlicoRiver Basin Buffer Rules Neuse River Basin Buffer Rules lf indicated on front of permit, your proiect is subiect 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 Resources. Contact the Division of Water Resources at the Washington Regional Office (252-945-6481) or the Wilmington RegionalOffice (910-796-7215) for more information on howtocomplywith these buffer rules. Division of Coastal Management Ofiices Morehead City Headguarters 400 Commerce Ave Morehead City, NC 28557 252-808-2808/ | -888-4RCOAST Fax: 252-247 -3330 (Serves: Carteret, Craven, Onslow - Nonh of New River lnlet- and Pamlico Counties) Elizabeth Citv District 401 S. Griffin St. Ste. 300 Elizabedt City, NC 27909 252-264-390t Fax:252-264-1723 (Serves: Camden, Chowan, Curituck, Dare, Gates, Pasquotank and Perquimans Counties) f] oth".' Washingon District 943 Washington Square Mall Washington, NC 27889 252-946-6481 Fax:257-948-M78 (Serves: Beaufort, Benie, Hertford, Hyde, Tyrrell and Washington Counties) Wilmington District I 27 Cardinal Drive Ext. Wilmington, NC 28405-3845 9t0-796-72t5 Fax: 9 I 0-395-3964 (Sewes: Brunswick, New Hanover, Onslow - South of New River lnlet- and Pender Counties) http://ponal.ncdenr.org/web/cm/dcm-home Revised 7/06/ I 7 CERTIFIED AIL . RETURN RECEIPT EQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION^^/AIVER FORM Name of Property g1runsr. TOWN OF EIVERALD ISLE Address of Property:LEE STREET CULVERT El\/E RALD ISLE NC 28594 Agent's Name # (Lot or Street #, Street or Road, City & County) TOWN OF EIMERALD ISLE Ir4 a iling Address: 7500 EMERALD DR Agent's p hone #. 252-354-8548 EI\,lERALD ISLE NC 28594 I hereby certlfy 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 d rawing_the development they are proposing A descri ion or drawino.dimensions, mu t be provided with th is letter _ I have no objections to this proposal I have objections to this proposal. lf you have obiectionsto what is being proposed, you must notify the Division of Coastal Management(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM o#ices rs available at htb://www.nccoastalmanadementnet/web/cn/staff-listino or by calting 1-8Bg-4RCOAST. /Vo respons e is considered the same as no obiection if yo u have been notified bV Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must be set back a minimum distance of '15'from my area of riparian access unless waived by me. (lf 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 (Property Owner lnformation Signature TOWN OF EMERALD ISLE (JOSH EDMONDSON) Print or Type Name 75OO EMERALD DR Mailing Address EMERALD ISLE NC 28594 Telephone Number / Email Address 5-12-20 (Riparian Property Owner lnformation) Signature ATHAN PARKER Pint or Type Name 7401 ARCHERS CREEK CT Mailing Address EMERALD ISLE NC 28594 City/State/Zip Telephone Number / Email Address Dale Date (Revised Aug. 2014) Ciy/Statezip 252-354-8 548 jedmondson@emeraldisle-nc.org CERTI FI ED MAIL.RETURN REC EIPT REQUES TED Address of Property LEE STREET CULVERT EI\iIERALD ISL E NC 28594 DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM Name of Property Owner: TOWN OF EIVERALD ISLE (Lot or Street #, Street or Road, City & County) Agent's Name #: TOWN OF EMERALD ISLE I\,4ailing Address: 7500 EMERALD DR Agent's phone # 252-354-8548 EIVERALD ISLE NC 28594 I hereby certiry that I own prope rty adjacent to the above referenced property. The individualapplying for this permit has descri bed to me as shown on the attached d rawing_the developmentescnithnslmueedthier - I have no objections to this proposal. _ I have objections to this proposal WAIVER SECTION i understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (lfyou 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 (Property Owner lnformation) ,4L'4*'t-- Signature TOWN OF EMERALD ISLE (JOSH EDMONDSON) Print or Type Name 75OO EMERALD DR Mailing Addr$s EIVIERALD ISLE NC 28594 City/State/Zip 252-354-85 48; jedmondson@emeraldisle-nc.org Telephone Number / Email Address 5-t2-20 (Riparian Property Owner lnformation) Signature KEVIN O'BRIEN Print or Type Name 7329 ARCHERS CREEK DR Mailing Address EI\4ERALD ISLE NC 28594 City/State/Zip Telephone Number / Email Address Date Date (Revised Aug. 2014) they are proposing. lf 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. Contact information for DCM otfices isavailableor by calling 1-888-4RCOAST./Vo response ls considered the same as no obiection if vou have notified bv Certifiedbeen CERTIFIED MA IL. RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONM/AIVER FORM Name of Property Owner:TOWN OF EIVIERALD ISLE Address of Property (Lot or Street #, Street or Road, City & County) Agent's Name #TOWN OF EIVERALD ISLE lVailing Address: 7500 EIVERALD DR Agent's p hone #: 252-354-8548 EI\i ERALD ISLE NC 28594 I hereb y certify that I own property adjacent to the above referenced property. The individual a ing for this pe rmit has described to me as shown on the attached drawin g-the development ey are p TO osrng A descri lon or drawin with dimensio st be rovided with this letter have no ob ections to this osal.I have objections to this proposal lf 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. Contact information for DCM offices is available at httplfuiww.nccoastalmanaoement.nevweucn/staff-listina or by calling 1-888-4RCOAST. No ,'esponse is considered the same as no objection if you have been notified bv Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must be set back a minimum distance of 15'from my area of riparian access unless waived by me. (lf you wish to waive the setback, you must initial the appropriate blank below.) @ f- r) I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement (Property Owner lnformation) at-,<:Z[*l- -(/ (Rip rope o er lnformation)a Signature si atLffe TOWN OF EMERALD ISLE (JOSH EDI\iIONDSON ) CHARLES UPCHURCH Print or Type Name 75OO EMERALD DR Mailing Address EMERALD ISLE NC 28594 City/State/Zip 252-354-8548: jedmondson@emeraldisle-nc Telephone Number / Email Address 5-12-20 Print or Type Name 1506 BALLENTINE DAIRY RD Mailing Address FUQUAY VARINA NC 27526 City/StaterZip q/26C lO l( a 6r'*Telephone Number / Email Addreis {-/9-2O (RevrsedAus.flSeElVED '14i.< Dqle org Dale l-l+ru0 oectvet**D MAY 26 ?o?o LEE STREET CULVERT EIVIERALD ISLE NC 28594 gl Culvert Replacement Location I 1 A (F \1-ilI tfr{-t rr -L \J \yP( -( NIil ,,\\.t)' \)- \fl 1- ( fl tr -.\ T 1 -1 k11 J ]+ 1T E fl ')- r { ) )r r \lIf.rlP Scope Remove asphalt, base, subgrade, retaining walls and culvert lnstall new culvert; 39 linear leet of 64"x43" diameter arched aluminum pipe lnstall two new 22'6"x7'3" fully welded aluminimum structural head walls Backfill once wall installation complete Place minimum of 6" stone base and minimum 2" asphalt at 20'for roadway repair Gama Permit Plan Lee Street Gulvert Replacement Town of Ermerald lsle 75OO Emerald Dr Emerald Isle NG 28594 252-35+3424 @ Map Created By Emerald lsle Planning Deparment May 12,2020 a ,ffi T .T r at Lti \ a CERTIFIED MAI L. RETURN RECEIPT REQUESTED DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM Name of Property Owner TOWN OF EIVERALD ISLE LEE STREET CULVERT EI\iIERALD ISLE NC 28594 (Lot or Street #, Street or Road, City & County) TOWN OF EIV]ERALD ISLE I\ilailing Address: 7500 EIVERALD DRAgent's Name #: Agent's phone #EI!{ERALD ISLE NC 28594 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 thev are proposinq. A description or drawinq. with dimensions. must be orovided with this letter. I have no objections to this proposal. _ I have objections to this proposal lf 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. Contact information for DCM ofrices is available at orby calling 1-888-4RCOAST. /Vo resp onse rs considered the same as no obiection it yo u have been notified by Certified Mail. WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must be set back a minimum distance of 15' from my area of riparian access unless waived by me. (lf you wish to waive the setback, you must initial the appropriate blank below.) (Prcperty Or..,ner !nfc:'rnaticn) f*.:4*u Signature TOWN OF EMERALD ISLE (JOSH EDMODNSON) Print or Type Name 75OO EIVIERALD DR Mailing Address EMERALD ISLE NC 28594 City/Statezip 252-354-8548; jedmondson@emeraldisle-nc.org Telephone Number / Email Address 5-1.2-20 {Ripana roperty Owner lnformation) s, JAMES POHL Mailing Address EI\,4ERALD ISLE NC 28594 City/Statezip Telephone Number / Email Address po Dqte 3 o2 (Revised Aug. 2014) Address of Property: 252-354-8548 I do wish to waive the 15' setback requlrement. /r' I do not wish to waive the 15' setback requirement. Print or Type Name 7402 CANAL CT Ddle CERTIFIED MAIL", RECEIPT ic Matl Only; No lnsuiance Cove@ge Provided)(Domesl U.S. Postal €lVlC€ ','u.s. IT Postal SewicdDelivery Confirmatiori"Receipt Postage and Dolivory Confirmaton fees must be pald betor8 malllng' Arlich So Tc (b b. coltlplobd bY meilci Kcdin O'Brien**'Vzn Arctte,s Ct"eY Emera{d Isle, Nc a?514 U- jce{ Fo6frndt llerg P0sTAt cu$0llllEB: (,€ep this eceipt. For lnquiri€[ Acc€ss intemst web site at www,usps.como or call 1 {0S222-1 8't i cfiEct( ot{E (Posr L tEC of{LY) EPdodty Mat"s"ni"" ERr*ctass iratPparcel m E.o Eru =n-Pu- _E=Eo8o So>tLdo f EmE r! .-g -JCE l_ ITr-E EEE Eru€ru ITEEr! ou* Eru =ta=a-Eu-S-SoEo8E rao$c-i.l o E mo .mE.n Sru EFs- Etri EE ErdE TEmo Fo.aC. Ceii0.d F.. B€t m Facalrl F.ta (Eido.s€cr.d n q-d, Reskiclod D€lrv6ry Fee (EndolEo66nl F6qukod) Toral Poeraoe & Fese u.s, JT W.tbo.d CHECX ofiE {Posral IEE ol{LY) Enuitv rrlat'seric" Flrst4lass lrdPParcel Prd€se S€n ic€E Parcel (se€ E vft6) PS Form 152, ir.y 2oO2 b.q< sluf uao Postmark Here b.?< slnltoao Pad€gB Sondcs3 parcd F.r a.v!G.) POSIAI CUSTOMER: Keep this r€ceipt For lnquirics: Access intemet web site at www.usps.con@ or call 1-800-222-1811 CHECK $IE (P(EIAI I}SE OI{LY) nPriotity u"tfs"*i"" Postal ServicdDeliuery Conlimatiofl Reccipt PGtaEs and 0€liYery Coffimaton Ess must be pald b€ffe malllng' &nch ScitTo: (b t conubH ry m'['O AlM.' Por|-d*W;i Ard',crs C-r.,Y C'^'* i^*aa rsp, t'Jc L85q4 . POSTAL CUSTOMER:w("ffi.0(t [:3.,ll;ffi.;|h:;,",#:l*',Here wwwusps.com@ 0,?{ or catl 1-8m-222-1811 u.s. tr Postal ServicdDelivery GonlirmatiortReceipl Pos{age and Dellvery Coflfirnaton le€s must be laid b8tul malling[ Arlhlo Sd To: (b b. co.n9br.d ry ttElLt) Janes Pohl***1qoL Canat Courl' Lqe,a.:ld- T-sla, t'l0 LSs?l WSkut sfnfaa^o PS Fom 152, MaY 2002 PS Form 1 52. llay 2002 Flrst4lass IilsiPPanol Pacl€ge Servlc6 Parct{ Fn F.{e$.) A" SlgrEhre E/eg"ntx c.r8 24 D. ls deliv€ry address diflercnt from item 1 ?Yes Nolf YES, enter d€livery address below: -Complete items l, 2, and 3' I Print vour name and addr€ss on the roverse so th;t we can rctum the card to You't-ba n E Addreasee t Attach this card or on the frcnt il 1. Anicle Addressed to: to the back of the mailpiece, space permits 9590 9402 3916 8060 9003 23 2. Anicle Number (franslet trcfi service labeJ) 030{o I q15L 5ao1 illlilll llll fi llli i illllllllllll ll lllll ll lll Adult $;natuB R€6tticisd oslivsrv c€rufi.d Msil Bdltic-t€d D€livsry Colloct on Dsllv€ry Rsstricted D€h'.€ry 3. Service TYP€ tr tr tr o tr tr oo El Priodv MtI EQIE6€O tr B€sisl..sd Mall tr B€qB€r.d Majl B6slrided tr Slsnstul6 Conlimatlonr tr Slg.stulE Conlirmatlon F6€tncisd Hiv€ry USEFFICIALt 3 $ 0.s{ For delivery lnlormation vislt our webElte at vrww.usps.comr ,$r9ls:ll 5\t, Cha.,:lce ^i,i,:lv;:i Iiot 3.tl A'tti'€Ei;: ZtP; Ses 8ee.l€ loi lnsrrucl,@rPS Forn 3800. Algusl 2006 B. Received bY (Pdnd ^lane) COMPLEIE iHIS SECiION ON DELIVERY SENDER: COMPLETE IHIS sECl'ON PS FOTM Jat 11, Juty zots psH zsao-02-000-9oss Marl Bcatncled o€livery DomoBtic R€tum RecelPt I I HeI€ Jamcs Pohl 11oz Cur*l Con* Evvrrtl Ot", lt ^nrrl usPSGAtBtq#'Trl.: il I ]ilt fl l I I tfillfl ffiril]r triillill lll lilll I ffi 1550 1q02 311r A0t0 l00l 1t United States Postal Service . Sender: Pleasg print your name, address, and ZIP+4o ln this box. TOWN OF EMERALD ISLE 75OO EMERALD DRIVE EMERALD ISLE, NC 8594 f4r9b{ /tre </--' iitlillllrlrlltltl,I,rllt[,,,lIrhrtllhil,ill,tl,,itltit,lt,t, USPS TRACKI{G # il r ill] ilil lffitriffiiilrililrllil l I I I ]t ilt ilt First-Class Mail Postage & Fees paid USPS Pemit No. G-10 United States Postal Service United States PostalService qsco cqnaB{r,G horo roo: or 'Sender: Plsase print your name, address, and ZIP+4o in this box. TOWN OF EMERALD ISLE 75OO EMERALD DRIVE EMERALD ISLE, NC 28594 iosMl cer.. Sr. l,,lI il,,l,, rrr lh llll, t, t,,ltll,lll,ltl,ltl,ltt,ltril l tli t,ltlt - I'SPS IRACKITIG # I]ilil] ilil ltflfli ffiltiltilit til 11 lt til i5i0 9q0e;f41t EOSO qOo: :o ' Sender: Please print your name, address. and Zlp+4.in this box. TOWN OF EMERALD ISLE 75OO EMERALD DRIVE EMERALD tsLE, NC ry594 So:,lr wa lillll,ll, ilNt il iltt t |, |, ll,t tllilillt\ tlililt,l, u, t\l First Class Mail Poslage & Fees Paid USPS Permit No. G-l0 B. B6c€h€d by (Prrrlbd r,rff e) r C,omplete items l, 2, and 3. ! Print your namg and address on the reverse so that We can return tho card to you. ! Attach this card to the back of the mailpiece, or on the front it space p€rmits. E Agent E Addra.o C. DatE of D€llve.y D. ls d€livqy addlEss difi€rEr ftom item 1?E Yes It YES, entor delivory addr6s.s b€low: E No R€l(rn B€oatst i 9s90 9402 3916 8060 9003 30 2. A,tcle Numb€r ffrarsfet hon srr,/i@ hbe| 70ut esa0 PS Fo.m 381 1, J'ry 20 0001 o?tq 0tht 1 5 PS,t 753G(P-eO-Ssci, Clwrlcs Uphu'& lSot Balle".{i'w' Dainl (d' Fu4m1Varina, ilc 1-ta,. fl il1il ilr ffi ilt Iffil!il1il[ ilt il ll ]t 0. Sorvico Typo El Pttdity Mdt Eer- O Adltt Sligrd|! tr BoofirrC Mdrtr ldt/t Signaluo R€.ti@d DCvey O B.lbE€d [A€f n 6Ed D C€.ti.d M.irO O.evry tr Cddi.d [.EI8dioa.d D.Iv..y O R.trn H..al, k D Cd.cron oalviy ilddrdldir. tr Colel on oolivry BsMd€d D*v.y tr Sligmfrr! Corfin doot tr llsuld Md tr Stgndun Cdtffil I Complete items 1,2, and 3. a Print your name and address on the reve6e so that we can return the card to you. r Attach this card to the back of the mailpiece, A" Signature cxru,,-b ts tr D Pidity Msn Een .O Agent c. or on the front if space Permits, 1. Article Addrossed tol D. ls ddlvsy add€ss difier€nt frorn ltem I lf YEs, elltor dollv€ry addEss bolow:F*o Yes A*hqn Brk, 11ol krchr:s Oe.U-Cori Emeo-td T"le, NC Lgsq+ iltilllr llll lllllll I illllilllllll lllllll lll Sorvico Type Adult siignd'rr6 Adult SiignalurB C€.ti6€d i.i€il@9s90 9402 3916 8060 9003 16 2. Anicl6 Number ffrarsfer ,toft svice tabe| tr R€gls!*d F€.tlct d o.fvsy tr 8€ge.dO€1"' c€.tif€d Mail F63tiicl6d ar.Ir v tr R.!,Il R.ciiPlld' irdrfitldb.Coll6ct on O6llv€ry Coll€cl on O€livsy R66tln€d Dilil. y tr SignstuB Coiilnndo.l B Sgndlr. Coniflrrdoi Majl R6rrict6d Er6llv6.y tr o tr tr tr tr D o B, Aec€ivod by lPrinfed ltame) FB Form 381 1 , July 2o'l 5 PSN 7a3{){2{oc's05s .4' COMPLETE THIS SECTION ON DELIVERY 1. Article Addressed to: t4 SENDER: cOMPLETE THts sEcTloN COMPLETE IHIS SECTION ON DELIVERvSENDER: COMPLErE IHIS SECIION r Complet€ items 1, 2, and 3. I Pfint your namo and address on the reverso so that wo can rsturn the card to you. r Aftach this Gard to the back ot the mailploco, or on the front i, space permits, 1. Articlo Addressed to: x lvt- r2 ol,qA" SignaturB dae"nt E Addr€saaa c D. ls delivery addr€ss difi6r€nt frcm ft€m 1? E Y63 lf YES, ontor dellv€.y add6ss b€low: tlr*(euin 0'Brierr 13aq tr,lc)\e(s Uer-tt Emirai.{ Trb, $C Urrf ilililr ilt 1ililil | |ilil1[il]t[ ilt IIMI 9s90 9402 3916 8060 9003 09 2. Article Numb€r or'arsfar lrom label) 03o+ to-?o ooot 1'152. 5'131 tr lnEumd Mail R€stdcl€d Osliv6ry Ps Fom 381 1 , JuV 201 5 prlN 75im-02-ooo-s053 Domaldc R€t t| R.c.t* i 3. S€nicsTYF tr RtorttyudEe|E-trfdutrSlgirfrtE A R.siEilaitfl tr Ad'Jt SitptlurE B6tbr6d lrCturr, tr R€{E !d iIsI n€slEd tr csrii!.d Mdlo D.lir.sy tr Crtf.d ir{tr R€3blct d D6lilgy tr Rdri n c.l, to. tr Colcct on lxlv.rv M*dundtD tr Col€ct o.| D€|lvori fk3tbt6d DEth/Ed O Sgnatir€ Coffimadonr tr tn uE tMsit tr Sgnaluft Coinmlstlo.r B. Boc€ived by (Pfhted ,Vatno) B. Rffiived by lfuinbd |la/,e) I Complot€ items 1, 2, and 3. a Plint your nimo and addr€ss on the reversg so that w6 can rgtum the card to you. r Attaah this cad to the back of the mailpiece, or on ths front if spaca '1. Micle Addressod to:D, ls d€li!€ry addrcss difbr€nt lrcm itsm 1? lf YES, 6rter d€liv€ry addrcss belor: trV Yes No A. SlgnsturE x .,{a a fi/1s*t E Addr6.. I 24 9590 9402 3916 8060 9003 23 2. Article Numb€r (frarshtfton s€wi.E labd) oso{L 53a1 Jamcs Pohl 1*oz Ca,u,l Co** €wral Islc, [C e?5s'l 3. S€,vicgTypo tr RbnqMdEeft- o rdlr sttftfrrD o R.eired MaIB o Ad'I si{peil,r a€&i.r6d [rdluy tr R.sE 3d MaI B-lc5ocitf€dM.Io ocvry tr Citif.d Md RdLt d l)crsy tr R.'n n B...lrtb. B CoLclorl Osrv*v M(fdraldb. O Co|l.cr * O*,r"ri nE.tlctca Dd'rey tr Slgislu€Cooffiitr o hsr.dM.il tr Slgistu. Cd|frmdo.r ps Form 38 1 1 , July 201 5 psN 7530-o2{oo-s053 Msil B6ticr€d O€liv6ry Oornoltlc Rttun Rocoht I i swice ot llltM fl ililil|iil ilttilr Iil]il il SENOER: CoMPLETE rHrs sEcrorv COMPLETE rHIS SECTION ON DELIVEBY SENDER: oOMPLETE fHtS SEcTloN COMPLETE THIS SECTION ON OELIVEBY