SC_20-09_ Harriss

RECEIVED
MAR 2 0 2020
Issued by WiRO SC20-09
Surf City Permit Number
DCM WILMINGTON,NC
CAMA
MINOR DEVELOPMENT
�i
PERMIT
NORTH CAROLINA
as authorized by the State of North Carolina, Department of Environmental Quality 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 John Harriss authorizing development in the Ocean Hazard (AECs) at 1103 N. Shore Drive, in Surf City, Onslow
County as requested in the permittee's application, dated February 18, 2020, and received by DCM on February 21, 2020.
This permit, issued on March 5, 2020, is subject to compliance with the application and drawing dated received by DCM on
February 21, 2020, (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:Addition to an existing structure.
(1) All proposed development and associated construction must be done in accordance with the permitted drawing received by
DCM on February 21, 2020.
(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) 796-
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 CAMA OCAL PERMIT OFFICIAL
this permit, require further written permit approval.All work must cease when this 127 Cardinal Drive Extension
permit expires on:
Wilmingto , NC 8405-3845
December31,2023
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 P RMITTEE
Management. (Signature requi d if conditions above apply to permit)

Name: John Harriss
Minor Permit#SC20-09
Date: March 5, 2020
Page 2 of 2
(4) The permittee is required to contact the Local Permit Officer [phone], shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days barring a major shoreline
change. Construction must begin within sixty (60) days of the determinationor the measurement is void and must
be redone.
(5) Any structure(s) constructed within the Ocean Hazard area 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.
(6) All structure(s) must be set back a minimum of 60 feet from the First Line of Stable Natural Vegetation (FLSNV), as
determined by the DCM,the LPO, or another assigned agent of the DCM.
(7) 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.
(8) Any structure authorized by this permit shall be relocated or dismantled when it becomes imminently threatened by
changes in shoreline configuration. The structure(s) shall be relocated or dismantled within two years of the time
when it becomes imminently threatened, and in any case upon its collapse or subsidence. However, if natural
shoreline recovery or beach renourishment takes place within two years of the time the structure becomes
imminently threatened, so that the structure is no longer imminently threatened, then it need not be relocated or
dismantled at that time. This condition shall not affect the permit holder's right to seek authorization of temporary
protective measures allowed under CRC rules.
(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.
NOTE: All construction must conform to the N.C. Building Code requirements and all other local, State and Federal
regulations, applicable local ordinances and FEMA Flood Regulations.
SIGNATURE: DATE: l �VO°7�
PERMITTEE

Issued by WiRO SC20-09
Surf City Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
NORTH CAROLINA
as authorized by the State of North Carolina, Department of Environmental Quality 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 John Harriss authorizing development in the Ocean Hazard (AECs) at 1103 N. Shore Drive, in Surf City, Onslow
County as requested in the permittee's application, dated February 18, 2020, and received by DCM on February 21, 2020.
This permit, issued on March 5, 2020, is subject to compliance with the application and drawing dated received by DCM on
February 21, 2020, (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:Addition to an existing structure.
(1) All proposed development and associated construction must be done in accordance with the permitted drawing received by
DCM on February 21, 2020.
(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) 796-
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 CAMA LOCAL PERMIT OFFICIAL
this permit,require further written permit approval.All work must cease when this 127 Cardinal Drive Extension
permit expires on:
Wilmington, NC 28405-3845
December 31,2023
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)

Name: John Harriss
Minor Permit# SC20-09
Date: March 5, 2020
Page 2 of 2
(4) The permittee is required to contact the Local Permit Officer [phone], shortly before he plans to begin
construction to arrange a setback measurement that will be effective for sixty (60) days barring a major shoreline
change. Construction must begin within sixty (60) days of the determination or the measurement is void and must
be redone.
(5) Any structure(s) constructed within the Ocean Hazard area 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.
(6) All structure(s) must be set back a minimum of 60 feet from the First Line of Stable Natural Vegetation (FLSNV), as
determined by the DCM, the LPO, or another assigned agent of the DCM.
(7) 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.
(8) Any structure authorized by this permit shall be relocated or dismantled when it becomes imminently threatened by
changes in shoreline configuration. The structure(s) shall be relocated or dismantled within two years of the time
when it becomes imminently threatened, and in any case upon its collapse or subsidence. However, if natural
shoreline recovery or beach renourishment takes place within two years of the time the structure becomes
imminently threatened, so that the structure is no longer imminently threatened, then it need not be relocated or
dismantled at that time. This condition shall not affect the permit holder's right to seek authorization of temporary
protective measures allowed under CRC rules.
(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.
NOTE: All construction must conform to the N.C. Building Code requirements and all other local, State and Federal
regulations, applicable local ordinances and FEMA Flood Regulations.
SIGNATURE: DATE:
PERMITTEE

Y� c� CY't) �� 10 -2�
LocalityCA Permit Number
. Ocean Hazard Estuarine Shoreline ORW Shoreline Public Trust Shoreline Other
(For official use only)
GENERAL INFORMATION
LAND OWNER-MAILING ADDRESS
Name JO)t Address 3!O _._°(ec'^3P' Qr, S-(e Z
City LAY; w �d�-- -- State �C— Zip /-a`(P) Phoned?,a" 5 20- 3 ' 4 y
Email Jo .
AUTHORIZED AGENT
Name `)q'4415 W I(I t 4-o4 )I0 I l d1_, J W�{ g N l G Did e_s LLG
Address_ )Z 1 M4-yro? L/U ----
City W I LAI 1 AgTo State N C _ Zip ?t/)Z Phone ell0 7Z ro - 4a31
Email h 12141 Nets 4a.kev . ca.v.
LOCATION OF PROJECT:(Address,street name and/or directions to site;name of the adjacent waterbody.)
I I 0 3 rtl. 5 Noes Du. 61R.? C rty
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) ENC l ost E-rs•rt,%
Le V 6 D Pour,' ) EM I L D 4 10' met 4-DDrnaa --To CrgArr of /*/ ) covet ees T
eF Aibt4Se w/ Asa o-n.- t Ft Dom.NS
SIZE OF LOT/PARCEL: square feet acres
PROPOSED USE: Residential j (Single-family ' ilti-family ❑ ) Commercial/Industrial ❑ Other ❑
COMPLETE EITHER(I)OR(2) BELOW(Contact your Local Permit Officer ifyu,i are not sure which AEC applies
to your property):
(1) OCEAN HAZARD 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: square feet(includes the area of the foundation of all buildings,driveways,covered decks,
concrete or masonry patios,etc. that arc within the applicable AEC.Attach your calculations with the project drawing.)
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subject tH,St lv E®
Stormwatcr Managem nt Permit issued by the NC Division of Energy, Mineral and Land Rcsgiiy�e �CMTI�aTON, NC
YES NO LJJLw�
-- - . . .. .. • .. . _ . 09f

OTHER PERMITS MAY RE 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, Beating and Air Conditioning, Insulation and Energy Conservation, HA
Certification,Sand Dune,Sediment Control, Subdivision Approval,Mobile Home Park Approval,I Iighway 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)
1 I � r rr''
/in owner or record title,Title is vested in name of UC,^"o`j5 Cte-- p. :got--J T
1-\'-(411
see Deed Book [-1 bl-`i page 314 k in the Peek 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 arc 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)(1) JAMES Wfl'2Q'6) /1OZ N. s1M-DYi P , Sut►V Crr /Pt. Z YJ
(2) J G g Qow^Q t/o 5 N c/> tt t r F C/ yeve .y -
(3) /. 55-"Y 8640 H4.4"1)5 bvtivN lot
(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 this permit application.
This the / day of ,��B ,20 za
Landowner or perso r orize o act as his/her agent for purpose of filing a CAMA permit application
This application ':chides:general information(this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AEC 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 of the application as described by these sources are
incorporated without reference in any permit which may be issued. Deviation from these details will constitute a vialatial L
any permit.Any person developing in an AEC without permit is subject to civil, criminal and administrat r
�f WTLMINGTON, NC
FEB 2 1 2020

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: JD N 1V 4A-ZEI55
Mailing Address: 390s OIec - Oc Sic Z-
Z et d 3
Phone Number: q (0-5 ZO- 311-tLf
Email Address: Jo�^'�� 1-.�r�i 5S e•���i �f S� S'�o�
I certify that I have authorized I/) f l)I MI Np/I )44- 1 JW 4 BSI 1b;G�S�I,LC,
Agent/contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: OAP G1 V/41 7 SPRY cp.
Et5'f f'�El r1 vJ1 PDRCN1 t 8utic,A 4 I*' /0 ' P02CH 4 E4 707-4R-D3 ST.
at my property located at It d 1 N S f'f"0ie tJIZ-
in PENt*f- County.
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 this
permit application.
Property Owner Information:
//(1
Signature
Print or Type Name
Dv,
Title
Z / 1 BSI 2owv
Date
RECEIVED
This certification is valid through / / DCM WILMINGTON, NC
FEB 2 1 2020

... ROY COOPER
fs
a I F.7
u MICHAEL S. REGAN
1 Secretary
BRAXTON DAVIS
March 4, 2020
John Harriss
3906 Oleander Drive,Suite 2
Wilmington, NC 28403
Dear Mr. Harriss,
Attached is CAMA Minor Development Permit SC 20-09 for work to be done at 1103 N. Shore Drive in
Surf City, Pender County. An electronic copy has been sent to the Surf City Inspections Department and
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.
Sin erely, 7
Tanya IEtila
Permit Support Technician
N.C. Division of Coastal Management
Enclosures
Cc:WiRO files
SC Inspection Dept.
James Holloway—Agent
State of North Carolina I Environmental Quality Coastal Management
127 Cardinal Drive Ext.,Wilmington,NC 28405

/ OCEAN HAZARD AEC NOTICE
Project is in an: Ocean Erodible Area High Hazard Flood Area Inlet Hazard Area
Property Owner: Goer -7 5 LAC- G,.J :Co l',"• 1ri 55
Property Address: )\p3 . Sti`O"1- - S C:4- NC_ •25/y45
Date Lot Was Platted:
This notice is intended to make you, the applicant, aware of the SPECIAL NOTE: This hazard notice is required for
special risks and conditions associated with development in this development in areas subject to sudden and massive storms and
area,which is subject to natural hazards such as storms,erosion erosion. Permits issued for development in this area expire on
and currents. The rules of the Coastal Resources Commission December 31 of the third year following the year in which the
require that you receive an AEC Hazard Notice and permit was issued. Shortly before work begins on the project
acknowledge that notice in writing before a permit for site,the Local Permit Officer must be contacted to determine the
development can be issued. vegetation line and setback distance at your site. If the property
has seen little change since the time of permit issuance,and the
The Commission's rules on building standards, oceanfront proposed development can still meet the setback requirement,
setbacks and dune alterations are designed to minimize, but not the LPO will inform you that you may begin work. Substantial
eliminate, property loss from hazards. By granting permits, the progress on the project must be made within 60 days of this
Coastal Resources Commission does not guarantee the safety of setback determination,or the setback must be re-measured.Also,
the development and assumes no liability for future damage to the occurrence of a major shoreline change as the result of a
the development. Permits issued in the Ocean Hazard Area of storm within the 60-day period will necessitate re-measurement
Environmental Concern include the condition that structures be of the setback. It is important that you check with the LPO
relocated or dismantled if they become imminently threatened before the permit expires for official approval to continue the
by changes in shoreline configuration. The structure(s) must be work after the permit has expired. Generally, if foundation
relocated or dismantled within two (2) years of becoming pilings have been placed and substantial progress is continuing,
imminently threatened, and in any case upon its collapse or permit renewal can be authorized. It is unlawful to continue
subsidence. work after permit expiration.
The best available information,as accepted by the Coastal For more information,contact:
Resources Com''n�J)ssion, indicates that the annual long-term
average ocea ev6sion rate for the area where your property is J/d 4-i L__
located is feet per year.
Local Permit Officer
The rate was established by careful analysis of aerial
photographs of the coastline taken over the past 50 years.
N.C. Dept. of Environmental Quality
rfLalso indicate that the shoreline could move as much as Division of Coastal Management
feet landward in a major storm. 127 Cardinal Drive Extension
Old waters in amajor storm are predicted to be about Wilmington, NC 28405-3845
�i feet deep in this area.
Preferred oceanfront protection measures are beach nourishment q i 0 ` Wes, — - -(3)- '
and relocation of threatened structures. Hard erosion control
structures such as bulkheads,seawalls,revetments,groins,jetties Phone Number
and breakwaters are prohibited. Temporary sand bags may be
authorized under certain conditions.
The applicant must acknowledge this information and
requirements by signing this notice in the space below. Without
the proper si ature,t application will not be complete.
RECEIVED
'L 7a tv DCM WILMINGTON, NC
Prop rty 0 ner Signature Date FEB 2 1 2020
Revised May 2010

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FEB 2 1 2020
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•
PIN: 4245-32-8997-0000 Sale Price: $132,000 Acres:0
Owner: WOLFE,JAMES L JR ET AL Sale Date: LAST_SALE_DATE Land Value:$210,104
4010 OLEANDER DR SUITE 11 Plat: 00110067 Building Value: $102,367
WILMINGTON,NC 28403 Account No: 974342 Total value: $312,471
Deed Ref: 4684/2948 Township: TOPSAIL Deferred Value:$0
Subdivision: DEL MAR BEACH Exempt Amount:0
Tax Codes: G01 C53 R40 PCL Class:R
Property
Address: 1103 N SHORE DR Heated Sq Feet:1344
Description: LT 10 PB 11/67 DEL MAR BEACH
7 p IZ E L i m iNkey Pto i PL 4ti1 S urt/Ey -4c
�c ALL 7rN1tNS1oNS -1✓F-0 nv Fj►S /Y�I4S�tz� iooL -
RECEIVED
DCM WILMINGTON, NC
FEB 2 1 2020

Receipts for
Certified Mail
Z/iOoZo _
(Staple Here)
Date
J L B 1ZPwro
Adjacent Property Owner
I1dS Al S1r-o2S A,z
Mailing Address
6112F (.rTyl NG z.?yy�
City,State,Zip Code//
Dear Adjacent Property: r
This letter is to inform you that I, ,'b H 1I4 PTl!S S have applied fora CAMA Minor
Property Owner
Permit on my property at 1/ C 3 Al 611-d71F DrZ • tit CJ'7T/, in Pender/Onslow
Property Address
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 (10— 7 Z b- Yi31 ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Surf City CAMA Minor Permit Program,you may submit
them to:
Jason Dail, Field Representative
NC Division of Coastal Management
Town of Surf City Local Permit Program
127 Cardinal Drive Extension
Wilmington, NC 28405
Sincerely,
JAJ 114-12visS
Property Owner •
/3S 5H1Py42D $LVIj
Mailing Address
w1L44 NC 1? Li /
City, State,Zip Code
RECEIVED
0CM WILMINGTON, NC
FEB 2 1 2020

U.S. Postal Servicee'
CERTIFIED MAIL® RECEIPT
n Domestic Mail Only
a For delivery information,visit our website at www.usps.com®.
H0L R a t ' a; • ;
* Certified Mail Fee $3.55 0406
$ 19_R5 02
Extra Services&Fees(check box,add teeypyppprgtyiate)
❑Return Receipt(hardcopy) $ 7v•VV."
❑Return Receipt(electronic) $ $0.00 Postmark
❑Certified Mail Restricted Delivery $ $0-ria Here
0 Adult Signature Required $ $0.00
❑Adult Signature Restricted Delivery$
D Postage $0.70
u $ 02/18/2020
Total Postage and Fees
$ $/.1a
✓ Sent TojL 3g lJN
St7et andnpt. o PO Box No.
City,State,ZiRkile
f 1t C!Tv NC ZIPPIC

:ernnea man service proviaes me lamming oenenis:
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electronic version.For a hardcopy return receipt,
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♦ r i. r
Receipts for
Certified Mail
(Staple Here)
Viiy?
Da
J944t$ GvAazEN
Adjacent Property Owner
list N SyORF DR
Mailing Address
6 4IZF C r7 A/c Y /5
City, State,Zip Code
Dear Adjacent Property:
This letter is to inform you that I, Jo ltN Y 122155 have applied for a CAMA Minor
Property Owner
Permit on my property at 11O 3 N• s li2 e D2 5WeT C 1-7/4/ in Pender/Onslow
Property Address
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 9 jD - 7z G - ,or by mail at the address listed below. If you wish to
Applicant's Telephone
file written comments or objections with the Surf City CAMA Minor Permit Program,you may submit
them to:
Jason Dail,Field Representative
NC Division of Coastal Management
Town of Surf City Local Permit Program
127 Cardinal Drive Extension
Wilmington,NC 28405
Sincerely,
JaHN 1-i4,Zrz,ss
Property Owner
$ SMIPifl72D BL vj,,
Mailing Address
1'Uj1 •r4, iv( Z8 `l/Z
City, State,Zip Code
RECEIVED
DCM WILMINGTON, NC
FEB 2 1 2020

U.S. Postal Service"
CERTIFIED MAIL° RECEIPT .
CI Domestic Matt Only
13 For delivery information,visit our website at www.usps.com"'.
t
Certified Mail Fee $3.55 0406
✓ $ $2.85 102
Yl Extra Services&Fees(check box,add reetp/> 'ate)
❑Return Receipt(hardcopy) $0 Return Receipt(electronic) $ 80 a 0�y0 Postmark
El Certified Mail Restricted Delivery $ $0.00 Here
0 Adult Signature Required $ $0 00
0 Adult Signature Restricted Delivery$
j Postage $0.70
$ 02/18/2020
U Total Postage and Foss.
1J
$ ?I
10
✓ Sent ro itt ,,5 , pti
i/ f�' fit'
Bt!/Onj Api(Vo..l oX D�
City ' +4^ rtY Aic z inr

;ertlnea Mall service proviaes me ronowing oenents:
A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail
A unique identifier for your mailpiece. associate for assistance.To receive a duplicate
Electronic vdrifiChtion ofd8livery or attempted return receipt fpr addfio0l1 fee,present this
delivery. USPS®-postmarked Certified Mail receipt to the
A record of delivery(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.
nportant Reminders: -Adult signature service,which requires the
You may purchase Certified Mail service with signee to be at least 21 years of age(not
First-Class Mate,First-Class Package Service*, available at retail).
or Priority Maile service. -Adult signature restrictedjlpllvery service,which
Certified Mail service is notavailable for requires the signee to be at least 21 years of age
international mail. and provides delivery to the addressee specified
Insurance coverage is not available for purchase by name,or to the addressee's authorized agent
with Certified Mat 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 bear a
certain Priority Mail items. USPS postmark.If you would like a postmark on
For an additional fee,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 portion
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 mailplece; IMPORTANT.Save this receipt for your records.

Date Date Check From Name of Vendor Check Check Permit Rct
Received Deposited Permit Holder Number amount Number/Comments
2/24/2020 James Holloway John Harriss Wells 2746 $100.00 minor fee, 1103 N Shore,Surf City JD rct.
Fargo PnCo 10972