NH_15-31_Dworsky

NEW HANOVER COUNTY 15-31
Local Government Permit Number
CAMA
MINOR DEVELOPMENT
PERMIT
as authorized by the State of North Caroana, Deparbnant of 8mrbomront,
and Neural Resources and the Coastal Resources Commisslon tor dawlopmwrc
In an win of arrehonment concern purauard. to Section 119h-113 of the
Genval Stahrtea, "Coastal Area Manoil m r
Issued to Louis D. Dworsky, authorizing development in the Estuarine Shoreline - ORW (AEC) at 413 Beach M, in
Wilmington, NC, as requested in the permittee's application, dated April 16, 2015. This permit, issued on June 10.2015
is subject to compliance with the application and site drawing (when; 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: Construction of Single Family Residence, Driveway, Septic System and associated Landscaping
(1) All proposed development and associated construction must be done in accordance with the permitted work plat
drawings(s) dated received on May 20, 2015
(2) All construction must conform to the N.C. Building Code requirements and all other local, Stale 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) A copy of this permit shall be posted or available on site. Contact this office at 910-798-7118 for a final inspection at
completion of work.
(Additional Permit Conditions on Page 2)
This permit action may be appealed by the oernitlee or other qualified persons
will m twenty (20) days of the lesLing dare. This permit must be an the project
site and accessible to the permit oflim when the pried is inspected for
comdiance. Arty matmenance work or project modification not covered under
We pamrit, require turtherwdtlen permit approval All work must cease when tots
pennt ehrylres on:
DECEMBER 31, 2018
In issukhg this permit 4 is agreed that this project is consistent with the local Land
use Plan and all appllcable, ord'nances. This permit may not be transferred to
ahwther parry without the written approval of the Dnisfan of Coastal
Management
Chris4neBouff
CAMA LOCAL PERMITOFFICIALf
230 Government Center D*# (f;V E D
Wilmington, "WILMINGTON, NC
JUN 1 12015
PERMITTEE
(Signature required coriditidns above apply to permit)

Name: Louis D. Dworksy
Minor Permit # 15-31
Date: June 10, 2015
Page 2
(5) The amount of impervious surface shall not exceed 25% of the lot area within 575 feet of Norma; High Water
(Estuarine Shoreline - ORW Area of Environmental Concern), in this case, 4,847 total square feet is authorzed.
(6) Unless specifically allowed in 15A NCAC 07H. 0209(d)(10), and shown on fhe pemtitted plan drawing, all
development/construction shall be located a distance of 30 feet landward of Normal High Water. No poftion of the
roof overhang shall encroach into the 30 ft, buffer.
(7) All urconsolidated material resulting from associated grading and landscaping shall be retained on site by effective
sedimentation and erosion control measures Prior to any land -disturbing activities, a barter One of fitter moth must
be installed between the land disturbing activity and the adjacent marsh or water areas, until such time as the area
has been property stabilized with a vegetative cover.
(8) Any proposed for grading withm the 30' buffer from the Normal High Water must be contoured to prevent additional
stormwater runoff to the adjacent marsh. This area shall be immediately vegetatively staoilized, and must remain in
a vegetated state.
(9) All other disturbed areas shall be vegetatively stabilized (planted and mulched) within 14 days of construction
completion
(10) This permft does not authorize the placement of fill
SIGNATURE:' DATE'
�E. TTEE
RECEIVED
DCM WILMINGTON, INC
JUN 1 12015

Locality
Ocean Hazard Estuarine Shoreline ORW Shoreline
LAND OWNER
Name Louis D. Dworsky - Double Dimension, LLC
Address 2324 Pansy St.
City Huntersville
Email
AUTHORIZED AGENT
Name Goodrich Architecture, PA
Address 3142 Wrightsville Ave.
(For official use only)
Permit Number E
Public Trust Shoreline Other
State AL Zip 35801 Phone [phone]
City Wilmington Sate NC
Email [e-mail]
Zip 28403
Phone [phone]
LOCATION OF PROJECT: (Address, street name and/or directions to site. If not oceanfront, what is the name of the
adjacent waterbody) 413 Beach Rd. North Figure Eight Island
DESCRIPTION OF PROJECT: (List all proposed construction and land disturbance.) New Single Family Residence
SIZE OF LOT/PARCEL: 34,624 square feet 0.79 acres
PROPOSED USE: Residential 0✓ (Single-family ❑� Multi -family Q ) Commercial/Industrial Other
COMPLETE EITHER (1) OR (2) BELOW (Contact your Local Permit Officer if you are not sure which AEC applies
to your property):
(1) OCEAN HAZARD AECs: TOTAL FLOOR AREA OF PROPOSED STRUCTURE: 2,777 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 rooFdrip line of all buildings, driveways, covered decks,
concrete or masonry patios, etc. that are within the applicable AEC. Attach your calculations with the project drawing.)
c�E4VED
STATE STORMWATER MANAGEMENT PERMIT: Is the project located in an area subjecrta,���`� NC
Management Permit issued by the NC Division of Water Quality? UUee
YES= NC� JUN 1 S 2015
If yes, list the total built upon area/impervious surface allowed for your lot or parcel: square feet.
!'ECEiVED MAY 2 Q 2015

OTHER PERMITS MAY BE REQUIRED: The activity you are 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, FIA
Certification, Sand Dune, Sediment Control, Subdivision Approval, Mobile Home Park Approval, Highway Connection, and
others. Check with your Local Permit Officer for more information.
STATEMENT OF OWNERSHIP:
I, 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)
F7an owner or record title, Title is vested in souk; D. Dworsky - Double D rnmelon, uc see Deed Book 4383
page 263 in the New Hanover County Registry of Deeds.
Elan owner by virtue of inheritance. Applicant is an heir to the estate of
probate was in County.
[Df other interest, such as written contract or lease, explain below or use a separate sheet & attach to this application.
NOTIFICATION OF ADJACENT 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)
(1) Paul A. Nussbaum - 4851 Bonita Bay Blvd. #804, Bonita Springs, FL 34134
(2) Gregory Henry Gach - 6000 Monroe Rd. Suite 350, Charlotte, NC 28212
(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 this permit application.
This the 16 day of April 20 15
;::�C-EIVED
DCM WILMINGTON, NC
authorized to act as his/her agent for purpose of filing a CAMA permit application J U N 1 S 2015
This application includes. general information (this form), a site drawing as described on the back of this application, the
ownership statement, the Ocean Hazard AF.0 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 violation of
any permit. Any person developing in an AEC without permit is subject to civil, criminal and administrative action.
RECEIVED MAY 2 0 2015 I�,-!

04/16115
Greaory Henry Gach
Adjacent Property Owner
6000 Monroe Rd. Suite 350
Mailina Address
City, State, Zip Code
Dear Adjacent Property:
U.S-
Postal
Service
CERTIFIED
MAIL.,
PECEIPT
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Coverage
Provided
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This letter is to inform you that I, Louis D. Dworsky have applied for a CAMA Minor
Property Owner
Permit on my property at 413 Beach Rd. North Figure Eight Island in New Hanover
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 retum
the enclosed no objection form. If you have any questions or comments about my proposed project, please
contact me at 910.343.1065
Applicant's Telephone
,or by mail at the address listed below. If you wish to
file written comments or objecfions with the county of New Hanover CAMA Minor Permit Program, you may submit
them to:
Christine Bouffard
New Hanover County Administration Annex
230 Market Place Drive, Suite 110
Wilmington, NC 28403
Sincerely,
Louis D. Dworsky
Property Owner
4851 Bonita Bay Blvd #804
Mailing Address
Bonita Springs, FL 34134
City, State, Zip Code
RECEIVED
DCM WILMINGTON, NC
JUN 1 8 2015
RECEIVED MAY 2 0 2015

04/16/15
a�—
Paul A. Nussbaum
Adjacent Property Owner
4851 Bonita Bay Blvd #804
Mailingg Address
Bonita Springs. FL 34134
City, State, Lp Code
Dear Adjacent Property:
U.S. Postal Service-
CERTIFIE71iAil.. '.lF ,7WT
(Dom=stir. Avail Daly No lnsu.ance Coverage
For Celaery w!ornru!:on visi±ao� wabs�te at
1°Fovoefd)
;''+ww.usVucmo
P9 F� "n 0. &m•'i 2rC.i�
_ '..
This letter is to inform you that I, Louis D. Dworsky have applied for a CAMA Minor
Property Owner
Permit on my property at 413 Beach Rd. North Figure Eight Island , in New Hanover
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 realm
the enclosed no objection form. If you have any questions or comments about my proposed project, please
contact me at 910.343.1065 ,or by mail at the address listed below. If you wish to
Applicants Telephone
file written comments or objections with the County of New Hanover LAMA Minor Permit Program, you may submit
them to:
Christine Bouffard
New Hanover County Administration Annex
230 Market Place Drive, Suite 110
Wilmington, NC 28403
Sincerely,
Louis D. Dwc
Property Owner
4851 Bonita Bay Blvd #804
Mailing Address
Bonita Springs, FL 34134
City, State, Zip Code
RECEIVED
DCM WILMINGTON, NC
JUN 1 8 2015
RECEIVED MAY 2 0 2415

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date -/S
Name of Property Dwnor Applying for Permit:
_0.A'jorskv C,f 0Ll[J% ��.,�ei+S,rI, LZ-C
Mailing Address:
623a14 `aanxV�S'f e-,4
AL -36901
I certify that I have authorized (agent) aodlf-; eh ArChr Uht t An act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date) i - Ito -
Property Owner Signature (� D7'Z
/
RECEIVED
DCM WILMINGTON, NC
JUN 1 82015
RECEIVED MAY 2 0 2915

AEG HAZARD NOTICE
Project Its in An.
Property £tamer:
Property
Onto Lot'
Ocean Erodible Area Koh Hard Flood Area X— Inlet Hazard Area
This notice is intimdod to make you. tbeapplicact, aware of the
spaciai risks and conditions associated with development in this
area, which is subject tct natural hazards such es storms, erosion
and currents, The rult s of the Coastal Rasomas Commission
regvizVthat you reo hmAnAECHozardlloticuand nkmvlcdgc
that notice in writing before a permit for deve onrnent can be
issuah
The Cornmission's Was on buh:ding standards, occsnrront
t4fteks and duets alteeationsaradcaigred to minimize, but not
chiminale. property toss From baauc:s. By Vinfirs hermim tlrc
ecasmi Rrsotercat f:.arrrm"ion does notsjuarantoe the safely of
the dcvtdcpmeut and assumes no liability for fttt uo damask to
the dcvclopmcnc lamps; isat.:d in flee Ocean tlazard Atea of
Envitonmental C onsem ioelu& the eandition that structures ns
rclecatedordismantlediftiiey beeotrte imminently dtrcat=Aby
changes in shoreline soatfiguratian.'rhe strucharc(s) must W
relocated or darn antled within two (2) years of becoming
Imminently iiireatenrd, and in any ease upnat its collapse nr
stbsidrnke_
Thee best availabic information, Ps Qoccpwd by the Coastal
Rowurcee Commission. indicates that the annual berg -term
avcrmgc c- an crusion raft: for the atea where your orop:Yey is
located Is feet per year.
Tim taco was est.uhlishod by careful analysis of atrial pzotographe
of the coastline taken aver the past Stt years.
$indite also indicate that the shoraline could move as Butch as
lbcl :andward in a major storm.
tic h'ooci waters in a otajor storm are predicted to b: about
__—feot de" in ttis area.
P:oferredoeeanfrontprotoetiwemcasurm are btaul.nourisiter ent
and reiocati rn of threaftncd structsnrea. Hard or"ien control
swuctu ssuchasbolkhwM,sC:awans,rcvetmrntk,groins,jet=
and brakwakis my prohibited. Temporary sand Sags may he
authorized
TtraWlicrntmustatknowictipthis mfortr d=and "imroxlts
by %iV:rks this notice in the irate below Witlmut the pnrtwr
sigpitum. the application will not be eorrtplctc.
LLc
SPECIAL NOTE: Thishanandttotica is,exiu:redfadesvioltiami
intreassobuttoueddenand massive stomtaand ep fir Pits
LLikecd I&developmcot in this areaexpire art Dtvambcr 31 ofthc
third year following the year in which tiro p m,;t was issued.
Shortly before worst begins on ft: pmjoct site, Ire Local Permit
t)(ticer most be corttactcd to dotemitto the vegetation line and
setback disdanceatyour shte Ifthepropertyirassoontitttaehangu
si0W the titru. atptxareit iaua tee, and tha proposed developutcat
can still meat the setback rvqu mment, the LPO wi:l inform you
that you may begin work. Substantial prc.gress. oat the ptojcct
must bo mndc within 60 days of tfnis sctbt ,lr determination, or
the setback must be r, measured. Also, tte coccurrence of a major
shoreline change a the result ofa storm wrhtlrirt 4w60-&yptxirud
will necMitait rernm=rement of the softd. It ha important
thatyera check with tlx; GPO below the permiiexpires forai8ciai
approval 10 continkm the work after the permit has expired.
Giraaerallyp iffountttationpilings hav¢bcca placed andvubttantial
progress is auttinuittg, perrelt reacevi can be uudrorized. It is
uniawrul to continue: work aft" pam9texpiration,
Am mrore i"ArAw on, contact:
• re
l ito3 by
1/0. 79w. rat / g
Phone t4Nnttteor
RECEIVED
DCM WILMINGTON, NC
JUN 1 8 2015
VEO MAY 2 0 Za46 Rot ae�rla

PIN
R03815-002-018-000
NEW HANOVER COUNTY
ENVIRONMENTAL HEALTH
230 GOVERNMENT CENTER DRIVE, SUITE 140
WILMINGTON, NC 28403
TELEPHONE (910) 79"667, FAX (910) 79&7269
IMPROVEMENT PERMIT
(A buildingpermit cannot be issued with only an hapromement Perma)
(Ezplres. five (5) yearsfrom date ofL=O
❑ Expansion 0 New ❑ Repair
Issued To: SWIFT, ROBERT
Property Location: 413 BEACH RD NORTH - LOT 17 - BLACK B - SECTION 18 - FIGURE 8 ISLAND
Type of Structure: SFD Type of Wastewater System: Va
Permit Number
ON0663383
File Namber
8373
Type of Water Supply: PUBLIC WATER SYSTEM Projected Daily Flow: 480 GPD
Number of Bedrooms: 4 Number of Employees: Number of Fixtures: _ Total Sq. Ft Bldg.: Max # of Seats:
Pump Required: ■ Yes ❑ No ❑ May be required based upon final location and elevations of facilities.
Site ImpPavemeaB rMWred prim m Canswwbm Autho undw lw mw
PROPOSED SYSTEM IS A PURARD PEAT MOFILTER CONSISTING OF 4 PEAT PODS SITUATED ON A GRAVEL BED 12 FT X 30 FT AT A TRENCH BOTTOM DEPTH OF SEVEN
(7) FT ABOVE MSL. TO ACHIEVE THIS TRENCH BOTTOM AND FINESHEDD GRADE OF 9.5 FT ABOVE MSI., SUITABLE FDA, MATERIAL. MUST BE INSTALLED ACCORDING TO
ATTACHED FILL PLAN. FILL MUST BE INSPECTED AND APPROVED BY NHC EHS BEFORE RELEASE OF AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION.
Authorized State Agent:
Date: 05/19/2015 See Attached Site Sketch
77m bwanarofthispenrdtbytkeNew Honorer Commy Heath DepsrtWeentatnowoyguaranteesrketseamreofoOh pennies Thcpernathaldairresponrib(efer
checking wkk appmpdaaegovendng bodies inmedittg thdrrequiranenn This site is subject to revocation if the site plan. plat or the tmendeduse changes The
Improvement Permit shall trot be affected by a change in the ownership of the site This permit is subject to compliance with the provisim a ofthe Laws and Rulesfar
.Sewage Trearementand Dtspamdand ioconditions ofthu permit.
DCM WILMINGTON, NC
JUN 1 S 2015
"Healthy People, Healthy Environment, Healthy Community"� 3

NEW HANOVER COUNTY
ENVIRONMENTAL HEALTH
230 GOVERNMENT CENTER DRIVE, SUITE 140
WILMINGTON, NC 28403
TELEPHONE [phone], FAX [phone]
Fill Plan ByhZ-•'��'T',� �'r tY
Date:
Permit Number
ON0663383
File Number
8373
Fill pad must be located in specific area indicated. Variations may result in the revocation of the Improvement Permit.
*" Fill plan Sketch (Not to Scalelll)"
Request Type: INITIAUNEWIRELOC
System Type: Va
Number of Bedrooms: 4
Septic Tank Size: 1,000
LTAR 1.0 Sq. Ft: 360
No. Lines: Length (ft):
Line Depth: 24
Fill Depth: 60
Fill Area (sq. fL): 1,600.00
1) Read fill plan carefultyl
2) Properly prepare approved septic location for
required fill to be added.
3) Landscaping of site by addition of fill onlyl
4) Place fill on site in EXACT location shown.
LEVEL surface of fill over system area and
buffer zone. Slope required. Call for a
FILL CHECK when ready.
5) No driving over any part of the septic system or
repair area!!
6) No decks, porches, sheds, patios, pools, etc.
over any part of septic system or repair area.
7) Keep all setbacks as shown!!
8) Keep 10 feet horizontal separation with
waterline from any part of the septic system
9) Keep 50 feet from any well serving a single
family dwelling or 100 feet from any well
serving multiple dwellings.
10) If there are any questions please call before
installation. [phone]
RECEIVED
DCM WILMINGTON, NC
JUN 1 S 2015
"Healthy People, Healthy Environment, Healthy Community" .im-"} I

File Number 8373
FILL PLAN FOR WASTEWATER SYSTEM
Fill
In some case your property can be modified in order to install a conventional or modified conventional
septic tank system. A commonly accepted Site Modification is the use of fill.
Fill is a specific amount of soil (sand to sandy loam) placed in an area designated for the septic system
to overcome limitations of the soil and site due to shallow soils, shallow seasonal high water tables, restrictive
soil horizons and other soil characteristics. Fill can be placed on a site to raise the area for the nitrification drain
lines so the suitable shallow soils can be utilized. The area and depth of the fill will vary due to the limiting soil
condition.
The following fill plan is for your proposed site and may be subjected to revision if the information
changes on your improvement permit.
Fill Plan for SWIFT, ROBERT
/JS Date:
Fill Proposal by: t(, C /i ( 4 z r - al= „� � �t
Design flow/day: 480
Application rate: 1.0
Total depth of fill (inches): 60
Total area of fill (sq ft): 1600
1- System and Buffer Zone (sq ft): 880
2. Length of Side Slope (ft): 5
6° bamy topsoil
' (,spa' sand to loamy sand'`
Total Length (ft): 50
Ton view /not to soa/al
�� 1? eiJe Slupc
s' nun-
s- n�J�, zono
r e
13 Sik tl�m°
Cross sections (not to stele)
6" loamy topsoil
'(�13 sand to loamy sand",,
Total width (ft): 32
Fill Procedure:
1. Prior to installation of fill, remove vegetation and root mat and disk fill area.
2. After the addition of 4" to 6" of sand of loamy sand fill, disk fill site again to provide a mix of fill and natural
soil to a depth of 6" below the natural ground surface.
3. Add enough additional sand or loamy sand fill to achieve a depth of (54") in system installation and buffer
zone area. This area including side slopes shall be covered with an additional 6" of sandy loam to loamy
topsoil to establish vegetative ground cover. Total depth of fill is (617').
4. Construct a 3:1 side slope as shown from the top edge of the fill tapered down to the natural ground surface.
5. Achieve level grade along axis of fill.
6. The fill system shall be shaped to shed surface water.
7. Call for re -inspection by Health Department.
8. After installation of the sewage system, the fill area shall be reshaped to shed surface water and seeded
with grass to establish vegetative ground cover.
HA iF IVED
Notes: Home site may need to be modified to insure gravity flow to system. Any setbac"WtOKOGTON, NC
measured from the outer edge of the fill.
JUN 1 8 2015
EHS Signature Date
This signature ath ms that the fie as described above has been checked and approved by the above Environmental Health specialist.
`SEE FILL PLAN SKETCH*"**
FILL PAD MUST BE INSTALLED IN AREA DESIGNATED BY HEALTH DEPT
'Healthy People, Healthy Environment, Healthy Community"

■ Complete items 1, 2, and 3. Also complete
Item 4If Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front M space permits.
1. Article Addressed to:
qre5Ory henry laeA
&Ooo /Y6nrve-Pd.,X.350
64Wrlo #c,Ne.,�Z
T
A. SQr/azure
X�/� O ABA
❑ Atltlre
D. Recased byLPdMn lNemal r. rlaeo.,r ,
D. 1s deelivvery address different from lMsrn 19 ❑ Yer
If YES, enter delivery address below. ❑ No
RECEIVEO MAY 2 0 2015
3. Service Type
❑ Certmwi Mall ❑ Fgreao Mall
❑ RatlMMW ❑ Return ReodPt for Merchandise
❑ Insured Mall ❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. Arficle Number 7012 3050 0000 0478 2605
(Transfer
s/er M1nrn service IabeQ
PS Form 3811, February 2004 Domestic Return Receipt 102596e2-M IS40
■ Complete items 1, 2, and 3. Also complete
item 4 M Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attacn tnis card to the back of the mailpiece,
or on the front if space permits.
1 Article Addressed ta:
'Paul A. NwLiaium
y85113aui+aB4 11VO al
SONI+a.4xixvs, Z3N134
2. Article Number
(Gamer from service label)
Ps Form 3811, February 2004
., ❑ Agent
❑ adore
by ( Printed Name) I C. Date of Delivery
D. is debery address different form item 17 ❑ Yes
if YES, enter delivery address below: ❑ No
RECEIVED MAY 2 0 2015
3. SWAM ryPe
❑ OMMW Mau ❑ Ftpreas Md
❑ Reuletered ❑ Return Reba for Merchandlae
❑ Insured Mail ❑ C.O.D.
4. Rsstriated DOINW t Pft Feel ❑ Yes
7012 3050 0000 0478 2612
Domestic Petum Rsaelpt
OVED
Mr, -TON NC
JUN 1 9 2015

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