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HomeMy WebLinkAboutCB_04-26_Dixon_Town of Carolina Beach_ Local Government CAMA MINOR DEVELOPMENT PERMIT as authorized by the State of North Carolina, Department of Environment, and Natural Resources and the Coastal Resources Commission for development in an area of environment concern pursuant to Section 113A-118 of the General Statues, "Coastal Area Management" _CB2004-26___ Permit Number Issued to limbo Dixon ___ , authorizing development in Ocean Hazard--__ at 809 Carolina Beach Ave. N as requested in the permittee's application, dated 5128/04 . This permit, Issued on June 14. 2004 , is subject to compliance with the application and site drawing (where consistent with the permit), all applicable regulations and special conditions and notes set forth below. Any violation of these terms may subject permittee to a fine, imprisonment or civil action, or may cause the permit to be null and void. This permit authorizes (1) All proposed development and associated construction must be done in accordance with the permitted work plat drawings(s) dated received 5/28/04 . (2) 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. (3) Any change or changes in the plans for development, construction, or land use activities will require a re-evaluation and modification of this permit. (4) This Permit is valid for demolition of a single-family home and construction of a duplex (5) Pursuant to NCAC, Subchapter 7J.0406(b), this permit may not be assigned, transferred, or otherwise disposed of to a third party. (6) All disturbed areas shall be vegetatively planted and mulched within 30 days of construction completion. This permit action may be appealed by the perrmittee or other qualified persons within twenty (20) days of the issuing date. From the date of an appeal, any work conducted under this permit must cease until the appeal is resolved. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. Any maintenance work or project modification not covered under this permit, require further written permit approval. All work must cease when this permit expires on December 31, 2007 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 Management, Permit Official (signature) Jeremy Hardison CAMA Local Permit Official Pernittee (sigma required if conditions above apply to permit) TOWNOFCAROLINABEACH PAGE 02 3-W rn i LAND OWNER 0 Address .sSo 9, State N� �— — — _ Zip oZ ? Co (01 Phone ALTTHORI7ED AGENT w Nam--- 1aA.-�-' Address l t> 2 _ .. City -'--- �� State N L Zip ,2gq pq Phone i (o 3 • E-7 G a LOCATION OF PROJECT: (.Address, srrecr name and/or directions to sire. If nor oceanfront, what is the na die adjar-enr watcrbody�) -_9 09 C eP t1..� 2 _ me of DESCRIPTION OF PROJECT.. (List all proposed construction and land disturbance.) SILF, OF LOTIPARCEL: _ (D a S o square feet — I PROPOSED USE; Residential �' awes (Single-family _— Multi -family _) Commerical/Industrial Other_._., __ TOTAL. ENCLOSED FLOOR AREA OF A BUILDING IN THE OCEAN RONMENTAL CONCERN ( HAZARD AREA OF ENV-1- —�� square feet (includes all floors and roof -covered decks) SIZE OF BUILDING FOOT (AEC): PRINT AND OTHER IMPERVIOUS � q _-- sq. ft OR BUILT -UPON SURFACES IN THE' COASTAL SHORELINE AREA OF ENVIRONMENTAL CONCERN (AEC): ICaL_ulations include the area of the roof/drip line of all buildings, driveways, covered decks, concrere or masonry parios, ecc. that are within dic applicable.AEC. Arrach your calculations with the project drawing,.) Choose the AEC area that applies to your property: (1) within 75 feet of Normal High Water for the Estuarine .Shoreline AEC (2) within 57S feet of Norma High Water for ncc Esmarinc Shoreline AEC, adjac,.nr to O!tsra.ndin, (3) Within 30 feet of the Public Trust Shoreline AEC t. t�brs�t ;rout Local Permit Officer if you are not sure which AEC: applies co.your property.) LATE STORMWATER MANAGEMENT PER -MI I': is the project located in an area sufsjerc to a Scare ycr r nxarr Mana.Semenc Permit issued by the iN f_hwsiou of Water tJua• lin> If vzs, h;a the n;ta1 built -upon �rca/iinpervious surface allowed For }•our lot or xrcel. _ __ 5^/",7.2"JP.= e12:14 9104582997 TO,Ii IJOFr•HROLIFJABFACFi PAGE 03 0114ER 1BERMITs MAY BE REO FARED: ]'he activin, you are planning may require permia other than the CAMA minor dcrslupment permit. Cis a service we have compiled a list of the kinds of permits char might be required. We suggest you ehcdlist treatrnenr system), Burning, Electrical, tvtth your LPO to determine if any of these apply to your proiccr. Zoning, t over the Drinking Water Well, Septic Iank (or other sanitary waste Plumbing, Hearing and Air Conditioning, Insulation and Energy Conservation, FIA Cercificad Sand Dunc, Sediment Control, Subdivision Approval, hiobilr. Home ParlcApptoval, Highway, Connection, and others. on, S'iATEMENT OF OWNERSHIP: 1, the undersigned, an applicant for a CA1v1A minor developmenr 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 dte 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) owner or record title. Tide is vested in 'b ^V,o � page _. in the _ V w - — — see Deed Book I ( C(S �� ^ �� County Registry of Deeds. owner by virtue of inheritance. Applicant is an heir to the estate of probate was in r —if other other interest, such as wricren contract or lease, explain below or use a separate sheet and attach to this application. NOTIFICATION OF ADJACENT PROPERTY ONVNERS: I furthermore certify That the following persons arc owners of properties adjoining this properry. I affirm that l have given ACTUAL NOTICE to each of them concerning my intent to develop [his property and to apply for a CAMA permit. (Name) (1) (2) (3) (4 ) ��f /tila`rt1Gw (Address) S O7 C GA. FOR DEVELOPERS IN OCEAN HAZARD AND ESTUARINE HAZARD AREAS: 1 acknowledge rhat [he land owner is aware char 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 nique.s. the particular hazard problems associ- ated with (his lot. This explanation was accompanied by- recorl mendations concerning the and Aoodproof[ng tech - PERMISSION TO ENTER ON LAND: I furthermore certify that I am authorized to grant and do in fact grant permission to dhe local permit officer and his agents In corer on chc aforementioned lands in connection with rvalua(ing information related to this permit application. 1 his application includes: gcnerai information !this form!, a Srtc drawing as described on the back of this application, the own=_Tship %MTcmenc, the A.EC hazard n '6k:C when: nheceSsar-y, a LLeLk h[r $100.00 made payable to the locality, and anyinfor- rnation as may be, provided orally by the applicant. The details of ehc application: as described by these sources are incorporated hOut reference in any permir which may be issued. Dmacion from these detals will constitute a violation of any permit. Arly person do doping in an AFC without permir is subject co civil.. cl i;ninal and adminiskrative action. This d-e 28 day of._M^ rU M M C2PostmaYR Rolm, Rocle,t Fee Hate (Evd.lso�,6111 Reel,1111d; (t3 Resid ct D&W.. Flo co fellrlorsamenl WILMINUIUN MPO A -th Carolina Total, 6 Fsta,Z 1- WILMINGTON, Not 284014044 3613950402-0096 M 05/28/2004 (910)313-3293 04:45:10 PM C3 ..................... S&i;gf, _AFT ?W: ---- 0 ------- - - ----- -- ----------- PO BOX NO. - Sales Receiptry, 6 - 'I ---0ArAirw_ V&ah A(je- tJ Product Sale Unit Description Final "C� AN.? r Oty Price Price CAROLINA BEACH NC 28428 $0.37 First -Class Return Receipt $1.75 Certified $2.30 Label Serial H: 70031680000160712983 Er Customer Postage 40.37 117 1 1-1 Subtotal: $4.05 n_1 ==Z====Z ra Issue PVI: $4.05 CAROLINA BEACH NC 28428 $0.37 First -Class Return Receipt 2.30 Fee Certified .M V Label Serial 0: 700316800001607$2990 R=rn"0let`FI Psearkr(Fdorament3e Customer Postage -$0.37 0 R'Stdolcl Dall'/Ity Fee Subtotal: $4.05 -0 SeqtIlred) Issue PVI: $4.05 r-1 Total Postage & 'Fees 28! "C. M CAROLINA BEACH NC 28428 $0.37 eW To First -Class 1:1 e ­V - - ---- -- -- .................... 0 orpo �4 1. Certified D I fli- &,�qh ) e, jj Return Receipt $1.75 r 70031680000160712976 1 n6 ------------------ I -- ---- Label Serial 9: $2.30 Customer Postage -$0.37 Subtotal: $4.05 Issue PVI: $4.05 Total: $12.15 M F13 Paid by: Er IvCash Change Due: $15.00 -$2.85 V:A Bill#: I000400292693 Clerk: io hrvmaik R.t.m R.de,l Fee All sales final on Stamps and postage. C, Refunds for guaranteed services only. Thank You for, Your business. E3 Reslrf.tor!D'j!,-rr,,. co (Undorso.itwntlai; Customer Copy _D M C3 .......... CA y-,) ne- 0 _0 O'g- nmng.�gg IMN &W-0111171 ft-w—Al C*,,% Dennis Barbour Mayor Jack Lynch Councilman Joel Macon Jr. Councilman TOWN OF CAROLINA BEACH 1121 N. Lake Park Boulevard Carolina Beach, North Carolina 28428 910 458 2986 / FAX 910 458 2997 Public Notice CAMA advertisement NOTICE OF FILING OF APPLICATION FOR CAMA MINOR DEVELOPMENT PERMIT Town of Carolina Beach Pat Efrid Mayor Pro Ten; Gary Doetsch Councilman Calvin R. Peck, Town Manager Pursuant to NCGS 113A-119(b), the Town of Carolina Beach, a locality authorized to issue CAMA Permits in areas of environmental concern, hereby gives notice that on May 28, 2004 , Plantation Homes applied for a CAMA Permit to demolish existing single family dwelling at: 809 Carolina Beach Ave N. Carolina. Beach, N.C. The application may be inspected at the address listed below. Public comments received by June 11, 2004 will be considered. Later comments will be accepted and considered up to the time of permit decision. Project modifications may occur based on further review and comments. Notice of the permit decision in this matter will be provided upon written request. Jeremy W. Hardison CAMA Local Permit Officer Town of Carolina Beach 1121 N. Lake Park Blvd. Carolina Beach, NC 28428 (910)458-2991 ( Please publish on June 4, 2004 ) Caption of Ad: CAMA Mail In voice and Affidavits of Publication to Attention of Lynn Prusa, Town Clerk, Town of Carolina Beach,1121 N. Lake Park Blvd, Carolina Beach, NC 28428. Thank You!) rLKIIHIlUll MUl'ILJ J1CIl OGO✓✓U CANAL DRIVE SITE 4� �W 4Z F- W Z 6 J� 1\/ Y1G7QiC VI O � ZQ � N UAKULINA OEAUH AVENUE N A R.WTIC OCEAN LOCATION MAP LOT 4 LOT 5 0 0 0 0 N N N z Z E%Is'�'roy i}u.rsa I R/W so.00' r-200' TO NORTHERN R/W OF OYSTER SHELL LANE 502'30'00"W 30' PUBLIC RIGHT OF WAY CAROLINA BEACH AVENUE NORTH NEW KANOWR CNATY .,yORTyTA+pkli yW I, SI4ART Y, R[N CN }%�O SWIIYYCp LECiEND CENTOY TbT THIS N,ID WAj•0I gta (Rpf`,W ACNC� FICLO NRKr NY Prnr�.tA VN1OEA O190MON.k1O ::� $LPCRN9ON. TNAT RA o OF PRECIRM 15 RET!ER • e THAN 1:10,040, AN nT!hNNS W-9 PpEPAR*U{'✓ I.P E.I.P. � IggON PIPE EtISNNC IRON PIPE q4P ACCGRBANCE MTH ARCS OP C.N. CONCRETE MONUMENT PRJ�CTIC(••FpN LAND RURYEYIN4 I R W4NESS yT RAW RIGHT OF WAY ORO 1 UNBOi• AN CL CENTER LINE TNl A0, .a PK A P.K. SURVEY NAIL 9ON RO3ESSI0Fg1�IT0fl 13470 BENSON & ASSOCIATES 'OTH ST., WIMNOTON. INC I L0T6 I R/w It SURVEY FOR JIMBO DIXON LOT 5, BLOCK 14 CAROLINA BEACH TOWNSHIP NEW HANOVER COUNTY, NORTH CAROLINA APRIL 21, 2004 DEED BOOK 942 PAGE 763 GRAPHIC SCALE ( at F1$'0 ) 1 loch = SO !L JUN. 2. 2004 10 SSRM yJPLRNTRTION HOMES 9107628550bWNOFCArCLINAKACH N0.620 P.3i5 PAGE 02 .v REOt1iRFD CAM A PERMIT NOTjITrI TIO Date: --- A o2$ a oo( To: SeS(� S l This letter has been hansmittad to you as required by CAMA.tu inform you that I (we) have applied for a CAMA pCratit on property located at 09 L�Ce(io, - Q-^-L' ArVe— N.N. Carolina Beach, N.C. LAMA Regulations require me (w) to notify you of my (our) intentiow. I (xre) have enclosed a copy of my (euy) pemtit application and plans of my (our) proposed project. No response within, tm (10) days is the same as no objection when you have been notified by Certified Mail. If you have any comments relative to this proposal, please contact: Charlotte Buckley, I.oCal CAMA permit Officer 1121 North Lake Park Blvd, Carolina Beach, NC 28428 (910)459-2526 Sincerely, TUN. 2.2004 10:55AM 91PLANTATION HOMES 9107628550owNOFCAroL-INAOEAcii NO.620 P.4 5PAGE gp R>:oYrriz>;n cnl�a PERn1rr Ivor_ ATION Date:�.ay This letter has been transmitted to you as required by CA IA to inform you that 1(we) have applied for a CAMA permit on property 1004ted at uC- Carolina Beach, N.C. CAMA Regulations requite me (us) to notify you of my (our) intentions. l (we) have enclosed a copy of my (our) permit applioation and plans of my (our) proposed Project, No response within ten (10) days is the same notified by Certified Mail. e9 no objection when you have been Tf you have any comments relative to this proposal, please contact: Charlotte 13gokley, Local CAMA Permit Officer 1121 North bake Park Blvd. Carolina Beach, NC 284.28 (910) 458-2526 Sincerely. PpQ aY,z JUN. 2.2004 ''10:55RM 71-'PLANTATION HOMES 9107626550•iWNUFCgf20LINA6EACH NO. PILll GE B2 •�' ► emu• ":��•,. • J' • Date:....`_ a aS X ocj' f To: T�dl L( —�, This letter has been transmitted to you as required by CAMA to inform you that I (we:) have applied for a CAMA permit on property or at • q� M . Carolina Beach, N.C, CAMA Regulations require me (us) to notify you of my (our) intentions, I (wa) bave enclosed a copy of my (our) permit application and plans of my (our) proposed project. No response within ten (10) days is the same as no objection when you have been notified by Certified Mail. If you have any comments relative to this proposal, please contact; Charlotte Buckley, Local CAMA permit Officer 1121 North Lake Park Blvd. Carolina Beach, NC 28428 (910)458-2526 Sincerely, Po6 ay73 W,I,K� fa /UC a Lato) 7oa3• t}7caa AEC HAZARD NOTICE Project Is In An: X— Ocean Erodible Area —High Hazard Flood Area_ Inlet Hazard Area Date Lot Was Platted: This notice is intended to make you, the applicant, aware of the special risks and conditions associated with development in this area, which is subject to natural hazards such as storms, erosion and currents. The rules of the Coastal Resources Commission require that you receive an AEC Hazard Notice and acknowledge that notice in writing before a permit for development can be issued. The Commission's rules on buildings tandards, oceanfront setbacks and dune alteration are designed to mirwnize,bu t not eliminate, property loss from hazards. By granting permits, the Coastal Resources Commission does not guarantee the safety of the development and assumes no liability for future damage to the development. The best available information, as accepted by the Coastal Resources Commission, indicates that the annual ocean erosion rate for the area where your property is located is feet per year. The rate was established by careful analysis of aerial photographs of the coastline taken over the pas t 50 years. Studies also indicate that the shoreline could move as much asl:falQ feet landward in a major storm. The flood waters in a majorstorm arepredicted to be about Ja-Lsfeet deep in this area. Preferred oceanfront protection measures are beach nourishment and relocation of threatened structures. Hard erosion control structures such as bulkheads, seawalls, revetments, groins, jetties and breakwaters are prohibited. Temporary devices, including sand bags, may be allowed under certain conditions. This structure shall be relocated or dismantled within two years of becoming imminently threatened. The applicant must acknowledge this information and requirements by signing this notice in the below space. Without the proper signature, the application will not be complete. -Apj5licanl's Signature (e/1 `% Dates SPECIAL NOTE: This hazard notice is required for development in areas subject to sudden and massive storms and erosion. Permits issued for developmentin this area expire on December 31 of the third year following the year in which the permit was issued. Shortly before work begins on the project site, the Local Permit Officer will determine the vegetationline and setback distance at your site. If thepropertyhas seen little change and the proposed development can still meet the setback requirement, the LP O will inform you that you may begin work. It is impor- tant that you check with the LPO before the permit expires for official approval to continue the work after the permit has expired. Generally, if foundation pilings have been placed and substantial progress is continuing, permit renewal may no t be necessary. If substantial progress has not been made, the permit must be renewed and a new setback line established. It is unlawful to continue work after permit expiration without this approval. For more information, contact: OMB L o c'NIPermit Ol icer I1a1 M. Lake Park bovlevat-,A ak—hlinA Z&ag /1r .sua8 Address ' gas M010 FROM WIN rKelffmil (atol �5i3-a9�B Phone Revised 11193 Dennis Barbour Mayor Jack Lynch Councilman Joel Macon Jr. Councilman TOWN OF CAROLINA BEACH 1121 N. Lake Park Boulevard Carolina Beach, North Carolina 28428 910 458 2986 / FAX 910 458 2997 Public Notice CAMA advertisement NOTICE OF FILING OF APPLICATION FOR CAMA MINOR DEVELOPMENT PERMIT Town of Carolina Beach Pat Efrid Mayor Pro Tem Gary Doetsch Councilman Calvin R. Peck, Tom Manager Pursuant to NCGS 113A-119(b), the Town of Carolina Beach, a locality authorized to issue CAMA Permits in areas of environmental concern, hereby gives notice that on June 9, 2004� Plantation Homes applied for a CAMA Permit to construct a residential duplex at: 809 Carolina Beach Ave N. Carolina Beach, N.C. The application may be inspected at the address listed below. Public comments received by July 1, 2004 will be considered. Later comments will be accepted and considered up to the time of permit decision. Project modifications may occur based on further review and comments. Notice of the .permit decision in this matter will be provided upon written request. Jeremy W. Hardison CAMA Local Permit Officer Town of Carolina Beach 1121 N. Lake Park Blvd. Carolina Beach, NC 28428 (910)458-2991 ( Please publish on June 25, 2004 ) Caption of Ad: CAMA Mail Invoice and Affidavits of Publication to Attention of Lynn Prusa, Town Clerk, Town of Carolina Beach,1121 N. Lake Park Blvd, Carolina Beach, NC 28428. Thank Youl) AREA CALCULATIONS Under Roof 1,948 s.f. Concrete 400 s.f. Total Impervious 2,348 s.f. aD N IT N 02°30'00" E 50.00' Lot 5 6,260 s.f. NVAC IatFortns I I 70 0 .....3' . .. .3. . U....... N.................. ........ LO N 31 of •,•,-Proposed to 0 0 m .'.'..'.Duplex.•.%%, �......... .......N rn CO....... ........ ....... '' CO Z ................. . N SI I ...... ....... .. 17.3........ 17.3''. Deck Deck o o — o o — — Q\ 12.0' 12.0' 4--) I Conc. Conc. (17 I D/W D/W o 6 1o.0' 10.0' O L /A 200' NOTE: — — — — 5 02"30'00" W 50.00' This map does not represent �04 a survey. Information shown hereon taken from a survey Carolina Beach Avenue by Stuart Y. Benson, P.L.5 June 7, 2004 This property A is is not Scale: 1"=20' Ref. D.Bk. c142, Pg. 763 in a_ special,flood zone as determined by the Department of Housing and I I 0�—�0' Drawn By: Keith Sabin Urban Development. 2 PLOTPLAN FOR: "limbo Dixon Residence" DRAFaT1NG Plantation,. Inc. 47ABINTS g OMPANY==q Lot 5, Block 14 18 HOLIDAY HILLS DRME 809 Carolina Beach Avenue North W1LMINGTON•NC•28�409 Carolina Beach Twsp., New Hanover Co., N. Carolina PH. 910313.2776•FAX 910,452r0378 0 M600 r94 r R77n FactNet Tax Data /Maps Pin: 313007 68 7970.000 PID: 08815-008-0 D 11 Prop: 809 N Carolina Beach Ave 9040 Sold: II/1981 $0 Zon: B-2 Vacot: N Tx Val: $116,196 9641 -%#, 72.00E cr3-m+- a6 AFFIDAVIT OF PUBLICATION STATE OF NORTH CAROLINA COUNTY OF NEW HANOVER AUG 0 5 2004 BY: Before the undersigned, a Notary Public of Said County and Sta e, PUBLIC NOTICE DIANE P. KEENAN CAMA ADVERTISEMENT NOTICE OF FILING OF Who, being duly sworn or affirmed, according to the law, says that he/she is APPLICATION FOR CAMA MINOR DEVELOPMENT PERMIT Town of Carolina Beach CLASSIFIED ADVERTISING MANAGER m_ of THE WILMINGTON STAR -NEWS, INC., a corporation organized and doing business under NA the Laws of the State of North Carolina, and publishing a newspaper known as WILMINGTON e- MORNING STAR & SUNDAY STAR -NEWS in the City of Wilmington on °a PUBLIC NOTICE CAMA ADVERTISEMENT NOTICE OF FILING OF APPLICATION at FOR CAMA MINOR DEVELOPMENT PERMIT Town of Carolina Beach Pursuant to ie. NCGS 113A-119(b), the Town of Carolina Beach, a locality authorized to issue CAMA Permits in areas of environmental cations may occur abased was inserted in the aforesaid newspaper in space, and on dates as follows: on further review and comments. Notice of the permit decision In this Q/2515 matter will be provided upon written request. Jeremy W. Hardison CAMA Local Permit Officer Town of Carolina Beach And at the time of such publication Wilmington Star -News was a newspaper meeting all the 1121 N. Lake Park Blvd. Carolina Beach, NC requirements and qualifications prescribed by SecG.S. of N.C. 2 (910) 458-2991 2991 Title: CLASSIFIED ADVER. MGR wo or affirmed to, and sp scrib d before me this j day of A.D. �e�anazanervr� In Testi ony Whereof, I have hereunto set my hand and affixed my ";6efi,.th&99 year afores td. My commission expires —/Y— day of 20g %. 4ti ,P Upon reading the aforegoing affidavit with the advertisement thereto annexed it is adjudged by the Court tfuu publication was duly and properly made, and that the summons has been duly and legally served on the defendant(s). This day of Clerk of Superior Court IuElI11117�71 cry'Aoo�-ab AFFIDAVIT OF PUBLICATION STATE OF NORTH CAROLINA COUNTY OF NEW HANOVER Before the undersigned, a Notary Public of Said County and State, DIANE P. KEENAN Who, being duly sworn or affirmed, according to the law, says that he/she is CLASSIFIED ADVERTISING MANAGER of THE WILMINGTON STAR -NEWS, INC., a corporation organized and doing business under the Laws of the State of North Carolina, and publishing a newspaper known as WILMINGTON MORNING STAR & SUNDAY STAR -NEWS in the City of Wilmington PUBLIC NOTICE CAMA ADVERTISEMENT NOTICE OF FILING OF APPLICATION FOR CAMA MINOR DEVELOPMENT PERMIT Town of Carolina Beach Pursuant to NCGS 113A-I19(b), the Town of Carolina Beach, a locality authorized to issue CAMA Permits in areas of environmental was inserted in the aforesaid newspaper in space, and on dates as follows: 614lx And at the time of such publication Wilmington Star -News was a newspaper meeting all the requirements and qualifications prescribed by Sec. No. 1-597 G.S. of N.C. Title: C ASSED ADV worn or affirmed to, and scrib d before me this day day of A.D., .4 In Testimony Whereof, I have hereunto set my hand and affixetm 00I0 ay and year aforesaid. L w� My commission expires day of �, 20( Y^ ` Upon reading the aforegoing affidavit with the advertisement thereto annexed it is adjudged by the CoWlra[ the said publication was duly and properly made, and that the summons has been duly and legally served on the defendant(s). This day of Clerk of Superior Court MAIL TO: