PN_18-11_ Piepmeyer

J
A _
Issued by WiRO PN18-11-Rev
Pender County Permit Number
CAMA
MINOR DEVELOPMENT AIC
PERMIT Coastal.Management
ENVIRONMENTAL aUALI'V
as authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission for development in an area of environment
concern pursuant to Section 113A-118 of the General Statutes, "Coastal Area
Management"
Issued to David and Sally Piepmeyer authorizing development in the Estuarine Shoreline (AEC) at 122 Broadview
Lane, in Hampstead, Pender County as requested in the permittee's application, dated June 6, 2018, and received by
DCM on June 8, 2018. This permit, issued on June 20, 2018, is subject to compliance with the application and drawing
dated and received by DCM on June 8, 2108 (where consistent with the permit), all applicable regulations and special
conditions and notes set forth below. Any violation of these terms may subject the permittee to a fine, imprisonment or
civil action, or may cause the permit to be null and void.
This permit authorizes: Construction of a 20'x 24' garage.
(1) All proposed development and associated construction must be done in accordance with the permitted site drawing dated
received by DCM on June 8, 2018.
(2) Any change or changes in the plans for development, construction, and/or land use activities will require re-evaluation and
modification of this permit.
(3) A copy of this permit shall be posted or available on site throughout the construction process. Contact this office at(910)
766-7221 for a final inspection at completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the permittee or other qualified persons
within twenty (20)days of the issuing date. This permit must be on the project
site and accessible to the permit officer when the project is inspected for Jason Dail
compliance. Any maintenance work or project modification not covered under C MA LOCAL PERMIT OFFICIAL
this permit,require further written permit approval.All work must cease when this
permit expires on: 127 Cardinal Drive Extension
December 31,2021 Wilmington, NC 28405-3845
In issuing this permit it is agreed that this project is consistent with the local Land
Use Plan and all applicable ordinances. This permit may not be transferred to
another party without the written approval of the Division of Coastal PERMITTEE
Management.
(Signature required if conditions above apply to permit)

_ A
Name: David and Sally Piepmeyer
Minor Permit#PN18-11
Date: June 20, 2018
Page 2 of 2
(4) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetated and stabilized (planted and
mulched)within 14 days of construction completion.
(5) All development shall be located at least 30' landward of the normal high water line.
(6) This permit does not authorize the excavation or filling of any wetlands,even temporarily.
(7) No impervious coverage/built upon area, including but not limited to the house (including eaves), foundation pad,
covered decking,etc. shall extend into the 30-foot coastal shoreline buffer.
(8) All structures shall comply with the NC Building Code, including the Coastal and Flood Plain Construction Standards
of the N. C. Building Code, and the Local Flood Damage Prevention Ordinance as required by the National Flood
Insurance Program. If any provisions of the building code or a flood damage prevention ordinance are inconsistent
with any of the following AEC standards,the more restrictive provision shall control.
(9) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
SIGNATURE: DATE:
PERMITTEE

r
Name: David and Sally Piepmeyer
Minor Permit#PN18-11
Date: June 20, 2018
Page 2 of 2
(4) All unconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures. Disturbed areas shall be vegetated and stabilized (planted and
mulched)within 14 days of construction completion.
(5) All development shall be located at least 30'landward of the normal high water line.
(6) This permit does not authorize the excavation or tilling of any wetlands, even temporarily.
(7) No impervious coverage/built upon area, including but not limited to the house (including eaves), foundation pad,
covered decking,etc.shall extend into the 30-foot coastal shoreline buffer.
(8) All structures shall comply with the NC Building Code,including the Coastal and Flood Plain Construction Standards
of the N. C. Building Code, and the Local Flood Damage Prevention Ordinance as required by the National Flood
Insurance Program. If any provisions of the building code or a flood damage prevention ordinance are inconsistent
with any of the following AEC standards,the more restrictive provision shall control.
(9) Pursuant to 15A NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, sold or otherwise
disposed of to a third-party.
RECEIVED
AUG 09 2018
DCM WILMINGTON, NC
•
SIGNATURE: DATE: c/o
Z 0 /
PERMITTEE

c, _
From:Simpson,Shaun
Sent:Thursday, August 02, 2018 2:32 PM
To: [e-mail]
Subject: Follow-up: CAMA Minor permit PN18-11
Good Afternoon Mr. & Mrs. Piepmeyer,
Attached is permit PN18-11 that was revised and sent to you by the USPS on June 20th requesting your signature. We
are required to have your signed copy on file in our office in order for the permit to be valid. Can you please sign the
attached copy, scan and return to me? Perhaps you did not receive the mailed copy, so I want to make sure both our
files are complete.
Thanks you for your prompt reply,
Shaun
Shaun Simpson
Permit Support&Customer Service
NC Department of Environmental Quality
NC Division of Coastal Management
127 Cardinal Drive Ext.
Wilmington,NC 28405
Phone:[phone]
[e-mail]
E-mail correspondence to and from this address
may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
From: Dail,Jason
Sent:Thursday,June 21, 2018 8:04 AM
To: Piepmeyer, David (GE Power) <[e-mail]>
Cc: Piepmeyer,Sally(GE Digital)<[e-mail]>; Simpson, Shaun <[e-mail]>; Gracie C.
Thomas<[e-mail]>
Subject: RE: [External] RE: CAMA Minor permit- PN18-11-Garage addition-Correction Request
My apologies. Revision attached.Thanks for noticing the discrepancy. Let me know if you need anything else.
Jason
Jason Dail
Field Representative
NC Department of Environmental Quality
NC Division of Coastal Management
127 Cardinal Drive Ext.
Wilmington,NC 28405
Phone:[phone],Fax:[phone]
Jason.Dail(a)ncdenr.gov
'E-mail correspondence to and from this address
may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
From: Piepmeyer, David (GE Power) [mailto:[e-mail]]
Sent:Thursday,June 21, 2018 3:19 AM
To: Dail,Jason <[e-mail]>
Cc: Piepmeyer, Sally(GE Digital) <[e-mail]>
Subject: [External] RE: CAMA Minor permit- PN18-11-Garage addition-Correction Request
Importance: High

• _ 4
Jason,
Thanks for sticking to the evaluation completion date you had stated. In my review of the attached permit, it states
that the construction is for a 10' X 24'garage. I had requested a permit to construct a 20'X 24'garage. Can you make
this correction and re-issue the permit? Thanks
David Piepmeyer
From: Dail,Jason [mailto:iason.dailPncdenr.govj
Sent:Wednesday,June 20,2018 4:52 PM
To: Piepmeyer, David (GE Power)<[e-mail]>
Cc:Simpson,Shaun<shaun.simpson(c ncdenr.gov>; Gracie C.Thomas<[e-mail]>
Subject: EXT: CAMA Minor permit- PN18-11-Garage addition
Good afternoon. Please find attached a copy of the subject CAMA minor permit.A signed hard copy will be mailed
tomorrow.
Feel free to call with any questions.
take care,
Jason
Jason Dail
Field Representative
NC Department of Environmental Quality
NC Division of Coastal Management
127 Cardinal Drive Ext.
Wilmington,NC 28405
Phone:[phone],Fax:[phone]
[e-mail] v
'E-mail correspondence to and from this address
may be subject to the North Carolina Public
Records law and may be disclosed to third parties.

ROY COOPER
41. Governor
MICHAEL S. REGAN
— Secretor,-
Coastal Management
ENVIRONMENTAL O UALITY BRAXTON DAVIS
Director
June 20, 2018
Dan &Sally Piepmeyer
122 Broadview Lane
Hampstead, NC 28443
Dear Mr. & Mrs. Peipmeyer:
Attached is revised CAMA Minor Development Permit PN 18-11 for work to be done at 122 Broadway
Ln., in Hampstead, Pender County. An electronic copy has been sent to the PN Co. Inspections
Department and to your agent.
To validate this permit, please sign both copies as indicated for our records. Retain the orange copy for
your files, and return the white copy to us within 20 days of receipt in the enclosed, self-addressed
envelope.
This is not a valid permit until it is signed and returned to our office.
Thank you for your prompt attention to this matter.
Sincerely,
Shaun K. Simpson
Permit Support Technician
Enclosures
Cc:WiRO files
PN Inspections Dept.
State of North Carolina I Environmental Quality I Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405
919 796 7215

P\...
I�Locality Permit Number 1 /l
. Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(For official use only)
A
GENERAL INFORMATION JUN 0 8 201$
LAND OWNER-MAILING ADDRESS .: i .
Name - D £ S
A t// 4CC t/ 1 CP/l'l CYE2 tvi r--__--
Address-----/ZZ ,0QO40 V/CO (An/C --_------ -
City_JIDiliVi)SFOID State A/C Zip ZYY 5 Phone 9/D — Z76 4— </ 7
l Email dAVLid. ,/Pfre y e (1644
( AUTHORIZED AGENT
Name A/ 4
Address - -,------_-- --
City State Zip Phone
Email•
LOCATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody.)
F/(o1 /A/rOlEcT,o, ' Dl Z/° A/o / 7/ -1-- A✓ TL //D/1i a,✓ A1// 7, 7
,e/6-H'T D--'TO 1Qe;02'/,4,t/4 7? 4t/Z e")v4, 74/C, - CAST LL'1-T 6i(7Z) A/104,OII/ V, �7D e7,/4 cc �At// e'h// /��N .�/61/r Odra (7,0 v-- i_ {//l/vt
/J P'C ) CD if cr A /0 64,0 o-E • fa.c0 ti 4/o yf e ,4 T , ,s/0i /C 41 / If-/M/C
DESCRIPTION OF PROJECT: (List all proposed con truction and land d' irbance.)
6ur�o/-✓G- 2V' z.0/ C�4/ZA/iE"e.44.o,2T -1,.✓ „(t- /T "gip SCE"
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SIZE OF LOT/PARCEL: — square feet A 1 acres ��� �� am
PROPOSED USE: Residential tgl (Single-family❑ Multi-family ❑ ) Commercial/Industrial ❑ Other ❑
COMPLETE EITHER(I)OR(2) BELOW(Contact your Local Permit Officer ifyou are no!sure which AEC applies
to your property):
(1) OCEAN IIAZARD AECs:TOTAL FLOOR AREA OF PROPOSED STRUCTURE: square feet(includes
• air conditioned living space,parking elevated above ground level, non-conditioned space elevated above ground level but
excluding non-load-bearing attic space)
(2) COASTAL SHORELINE AECs: SIZE OF BUILDING FOOTPRINT AND OTHER IMPERVIOUS OR BUILT
UPON SURFACES: gk9Zsquare feet(includes the area of the foundation of all buildings,driveways,covered decks, (2
-concrete or masonry patios,etc. that arc within the applicable AEC.Attach your calculations with the project drawing.) Z.
a1--
w�
STATE STORM WATER MANAGEMENT PERMIT: Is the project located in an area subject to a State ?z _Y
Stormwater Mana ement Permit issued by the NC Division of Energy,Mineral and Land Resources(DEMLR)? v a.YES_ — NO w§
If yes,list the tota built upon area/impervious surface allowed for your lot or parcel: —square feet. v
0

SITE DRAWING/APPLICATION CHECKLIST
Please make sure your site drawing includes the following information required for a CAMA minor development permit.
The Local Permit Officer will help you, if requested.
PHYSICAL DIMENSIONS
Label roads
Label highways right-of-ways
Label local setback lines
Label any and all structures and driveways currently existing on property
Label adjacent waterbody
PHYSICAL CHARACTERISTICS
Draw and label normal high water line(contact LPO for assistance)
Draw location of on-site wastewater system
If you will be working in the ocean hazard area:
Draw and label dune ridges(include spot elevations)
Draw and label toe of dunes
Identify and locate first line of stable vegetation(contact LPO for assistance)
Draw and label erosion setback line(contact LPO for assistance)
Draw and label topographical features(optional)
If you will be working in a coastal shoreline area:
Show the roof overhang as a dotted line around the structure
Draw and label landward limit of AEC
Draw and label all wetland lines(contact LPO for assistance)
Draw and label the 30-foot buffer line
DEVELOPMENT PLANS
Draw and label all proposed structures
Draw and label areas that will be disturbed and/or landscaped
Note size of piling and depth to be placed in ground
Draw and label all areas to be paved or graveled
Show all areas to be disturbed
Show landscaping
NOTE TO APPLICANT
Have you:
• completed all blanks and/or indicated if not applicable?
• notified and listed adjacent property owners?
• included your site drawing?
• signed and dated the application?
• enclosed the$100.00 fee?
• completed an AEC Hazard Notice,if necessary?(Must be signed by the property owner)
FOR STAFF USE
Site Notice Posted Final Inspection Fee Received
Site Inspections
•
Date of Action: Issued Exempted Denied Appeal Deadline(20 days from permit action)

l
OTiiER PERMITS MAY BE REQUIRED:The activity you arc planning may require permits other than the CAMA
minor development permit,including,but not limited to: Drinking Water Well,Septic Tank(or other sanitary waste
treatment system), Building, Electrical, Plumbing, Heating and Air Conditioning, Insulation and Energy Conservation, HA
Certification, Sand Dune,Sediment Control,Subdivision Approval, Mobile i Iome Park Approval,I lighway Connection,and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
1,the undersigned,an applicant for a CAMA minor development permit,being either the owner of property in an AEC or a
person authorized to act as an agent for purposes of applying for a CAMA minor development permit,certify that the person
listed as landowner on this application has a significant interest in the real property described therein.This interest can be
described as:(check one)
an owner or record title,Title is vested in name of ,Q Vie / /C 4'1 ,
see Deed Gook page in the /E /WOc7L County Registry of Deeds.
an owner by virtue of inheritance.Applicant is an heir to the estate of
;probate was in County.
if other interest,such as written contract or lease,explain below or use a separate sheet&attach to this application.
NOTIFICATION OF ADJACENT RIPARIAN PROPERTY OWNERS:
I furthermore certify that the following persons are owners of properties adjoining this property. I affirm that I have given
ACTUAL NOTICE to each of them concerning my intent to develop this property and to apply for a CAMA permit.
(Name) (Address) f
(I) -,o etti /J/t t Al//t=�( /20 Q2oAOUici,1 t44/C l`7�tMfSia-)t
(2) _ 4Ar1,f7-,ao in421o/A /Z 9 .0,4640 V/tom✓ t4'VC gQMPST <4
(3) —
(4) - - --- — - - -
ACKNOWLEDGEMENTS:
I,the undersigned,acknowledge that the land owner is aware that the proposed development is planned for an area which
may be susceptible to erosion and/or flooding. I acknowledge that the Local Permit Officer has explained to me the particu-
lar hazard problems associated with this lot.This explanation was accompanied by recommendations concerning stabiliza-
•
tion and floodproofing techniques.
i furthermore certify that I 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 tl • permit application.
// tI,
This the [P — day of J xi/ ,20 /d
ki 7 -
Landowner or person auth ized t act as his/her agent for purpose of filing a CAMA permit application
V
This application includes:general information(this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean//azandAEC Notice where necessary; a check for$100.00 made payable to the locality, and
any information as may be provided orally by the applicant. The details oldie application as described by these sources are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a violation of
any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action ECEIVED
DCM WILMINGTON• NC
JUN 0 8 2018

Receipts for
Certified Mail
(Staple Here)
Date
Adjacent Property Owner
Mailing Address
City,State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, have applied for a CAMA Minor
Property Owner
Permit on my property at ,in
Property Address City!Town
in Pender County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form. If you have any questions or comments about my proposed project,please
contact me at ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail, DCM Field Representative
LPO,County of Pender
NC DEQ!DCM
127 Cardinal Drive Ext.
Wilmington, NC 28405
Property Owner
Mailing Address
City,State,Zip Code

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Imprevious Structures- Piepmeyer
Current Structures Length Width Total Square Feet
House 44 24 1056
Covered Porches 44 10 440
Breezeway &Garage 24 22 528
Cement Driveway 130 12 1560
Cement Parking 24 22 528
4112 sq feet
Proposed Detached Garage 24 20 480
Total Imprevious Area = 4592 Sq Feet
Total Lot Size =—1 Acre 43560 Sq Feet
****Approximately 11%of total lot will be imprevious if proposed garage is permitted***
RECEIVED
DCM WILMINGTON, NC
JUN 08 2018

Receipts for
Certified Mail
(Staple Here)
yV/ZoiPsT-E-ziD 14q ,,✓,4 — L1
Adjacent Pro erty Owner
Adjacent
£o /LJDoD S7
Maj{Wng Address 7 G`'
L)ungA � N C z si z
City,State,Zip Code
Dear Adjacent Property: n
This letter is to inform you that I, /14 VI,a /t C/j'1ekg have applied for a CAMA Minor
//�� Property Owner /'//
Permit on my property at )ZZ &/.6QD V/E�J t4,V'E ,in //f M S72Q4 '
Property Address City I Town
In Pender County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form.If you have any questions or comments about my proposed project,please
contact me at Z70 O S/ 9 ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail,DCM Field Representative
LPO,County of Pender
NC DEQ I DCM
127 Cardinal Drive Ext.
Wilmington,NC 28405
dA t/r O ,/E-Aleit-7Z.
Property Owner
/ZZ &OA.() y/ELJ �,rE
Mailing Address
//4/1flp—xt o A/C ZYV'I
City,State,Zip Code
RECEIVED
DCM WILMINGTON. NC
JUN 08 2018

,
a
,
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to J4C L y £ 714 V%, 4/646-va ,s
d(e--6
(Naame of Prope Owner)
property located at /Z Z AO iI 62,1 4�r; 4,472crC /V(
--- (Address, Lot, Block, Road,etc.)
I- (1 Li
on , in Pender County, N.C.
(Waterbody)
He/She has described to me as shown in the attached application and project drawing(s),the development he is
proposing at that location,and, I have no objections to his proposal,
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Type Name
Telephone Number
Date

1. . •os a ervuce
CERTIFIED MAIL® RECEIPT
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3 Certified Mall Restricted Delivery $ Here
3 Li,--,
Adult Signature Required
Adult Signature Restricted Delivery$
3 Postage
71
$
2018
Total Postage and Fees
rl
O Sent To
a
3 Street and Apt.No.,or PO FlaiWo.
City State,ZIP+44

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✓A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
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Important Reminders: -Adult signature service,which requires the
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electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
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Receipts for
Certified Mail
(Staple Here)
Lad
S u� 12/A/467
Adjacent Property Ow per
gig Ale-7r /(NoV4i-1 CLC
Maili g e
kiILAddrMI.tss,cr. t/ ZO ]'pI/i)7
City,State,Zip Code
Dear Adjacent Property: /�
This letter is to inform you that I, Al VI,/) /t! ;16--1 have applied for a CAMA Minor
/� Property Owner / //
Permit on my property at )ZZ �/040 U/[=�J C4/6 in ry'4'��5�?��
Property Address City!Town
In Pender County. As required by CAMA regulations, I have enclosed a copy of my permit application and
project drawing(s)as notification of my proposed project.No action is required from you or you may sign and return
the enclosed no objection form. If you haveany questions or comments about my proposed project, please
contact me at Z7o O S/ ( ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the CAMA Minor Permit Program,you may submit them to:
Jason Dail, DCM Field Representative
LPO,County of Pender
NC DEQ!DCM
127 Cardinal Drive Ext.
Wilmington, NC 28405
DA100 ,/6741/67/6.�
Property Owner
/ZZ ZLGA4 )//E0 LAA✓r
Mailing Address
jet O Z V?
City, State,Zip Code
RECEIVED
DCM WILM NG ON, NC
8 2`l ii

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
FOR CAMA MINOR PERMITS
I hereby certify that I own property adjacent to 54L C y £ ad vo 4-40&SEX 's
(Name of Prope Owner)
property located at /Z Z ,)1ZOA 0 ✓/E.L' LQ Air / ,vi cTc4J 1 C
(Address, Lot, Block, Road,etc.)
()&i
on y , in Pender County, N.C.
(Waterbody)
He/She has described to me as shown in the attached application and project drawing(s),the development he is
proposing at that location,and, I have no objections to his proposal.
(APPLICATION AND DRAWING OF PROPOSED DEVELOPMENT ATTACHED)
Signature
Print or Type Name
Telephone Number
Date

I. . •os a ervice
CERTIFIED MAIL® RECEIPT
Domestic Mail Only
For delivery information,visit our website at www.usps.com'''.
I ii.,1.11N174.i: ; 0
Certified Mail Fee _
D
D $
Extra Services&Fees(check box,add lee al a;iier7419)
0 Return Receipt(hardcopy) $ i
3 0 Return Receipt(electronic) $ ::; Postmark
3 El Certified Mail Restricted Delivery $ ". Here
3
Adult Signature Required
Adult Signature Restricted Delivery$
Postage
D $ 71
Total Postage and Fees 06/06/201$
6.91
1:1 Sent To
Street and Apt.No.,or 1507foiiiVo.
City,State,ZIP+46

HGr 111I0Y IVIPO.7c4 vwc I.J.V11H.W LI IC IVIIVVIIIU LOGrrcrrt0.
r A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
I A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
r Electronic verification of delivery or attempted return receipt for no additional fee,present this
delivery. USPS®-postmarked Certified Mail receipt to tht
r A record of deliver(including the recipient's retail associate.
signature)that•is retained by the Postal Service" -Restricted delivery service,which provides
for a specified period. delivery to the addressee specified by name,or
to the addressee's authorized agent.
Important Reminders: -Adult signature service,which requires the
r You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mail',First-Class Package Service', available at retail).
or Priority Mail®service. -Adult signature restricted delivery service,whicl
I Certified Mail service is not available for requires the signee to be at least 21 years of a5
international mail. and provides delivery to the addressee specifies
r Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agen
with Certified Mail service.However,the purchase (not available at retail).
of Certified Mail service does not change the •To ensure that your Certified Mail receipt is
insurance coverage automatically included with accepted as legal proof of mailing,it should bean
certain Priority Mail items. USPS postmark.If you would like a postmark on
r For an additional tee,and with a proper this Certified Mail receipt,please present your
endorsement on the mailpiece,you may request Certified Mail item at a Post Office'"for
the following services: postmarking.If you don't need a postmark on this
-Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portior
of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply
You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.
electronic version.For a hardcopy return receipt,
complete PS Form 3811,Domestic Return
Receipt.attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
/AM ._„.v..e in_..r_ocu'IC nn nnw..._m.�

Date Date Check From Name of Vendor Check Check Permit Rct. #
Received Deposited Permit Holder Number amount Number/Comments
6/8/2018 David A. Piepmeyer David and Sally Alliance 5841 $100.00 minor fee, 122 Broadview TP rct. 6185
Piepmeyer Credit Lane, Hampstead PNCo
Union