Hicks, Don & Stephanie - 88971C

#E]New
❑CAMA ElDREDGE& FILL N9 88971 A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC Rules attached. ❑ General Permit Rules available at the following link: www.deq nc gov/CAMArules
Applicant Name t' "li 1YhP I" 1 C IS
Address -
City 'i State `' �i zip lf`c—ql-i
Phone#(
Email ln; Ck V1e-�"
Authorized Agent J- C i O CI V�
Project Location (County): i ..-i .i.0 V C-A-
StreetAddreWState Road/Lot #(s)
n yy 1�1 r
Subdivision \j kc,, C�( 1 -J
city(- ��lryClIA TIc,. ZIP
Affected ❑ C W
❑ EW ❑ PTA
❑ ES
❑ PTS Adj. Wtr. Body �!'!:I 1- l{ `Y l t s r'\ 61 i=.
� (nat/man/unk)
AEC(s): ❑OEA
❑ IHA UW
❑
❑ SPIMA
:, II \.
❑ PWS Closest Mal. Wtr. Body
ORW; yes/no
PNA: yes/no
Type of Project/ Activity
(Scale:
Shoreline Length
Access Length
Pier(dock)length
Fixed Platform(s)
!I-_
I
{
iS
j
-"
-
—
�41"
I
T
I
Floating Platform(s) !
Finger pier(s) y'
Total Platform area
Groin length/M -'
Bulkhead/ Riprap length
Avg distance offshore
�—
1
•C.y��
—
Breakwater/Sill '—
i—
I
z`
Maxdistance/length
Basin, channel
-
-
—
—
---
Cubicyards
�
_—
—�
-
C
Boat ramp
Boathouse/ Boatlifit _
y
s
t
s
Beach Bulldozing
rt
�
Other
-
i
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
—
—
A building permit/zoning permit may be required by:=
Permit Conditions'
OF
Agent or Applicant PRINTED Name
ll FY t'vno
fil (V ❑ TAWPAM/NEUSE/BUFFER(circle one)
F] See note on back regarding River Basin rules
AND REVIEWED
Permit Officer's PRINTED Name
❑ See additional notes/conditions on back
(Please
Signature **Please read compliance statement on back of permit**
Application Fee(s) Check #/Money Order
Signature
Issuing Date
Expiration Date

d,(Wr",&❑CAMA ❑ DREDGE & FILL ND 88971 A B C D
GENERAL PERMIT Previous permit
� Date previous permit issued %
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC �� ❑ Rules attached. ❑ General Permit Rules available at the following link: v ww.deq.naPoy/CAMArules
Applicant Name
Address "T
„t
City i State ZIP
Phone # ( )
Email
Affected ❑ CW ❑ E W ❑ PTA ❑ Es ❑ PTS
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS
r...
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Leneth
Authorized ,agentProject Location (County):
Street Address/State Road/Lot #(s) 5 I
.—� �.,\�.l i- ii•1 Yam_
Subdivision's%�-/
City-..I,i .�)C' ZIP
Adj. Wtr. Body i • ,
Closest Maj. Wtr. Body
(Scale:
Access Length
Pier(dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
I
Total Platform area
i
�_
!
Groin length/q /
i
-
Bulkhead/ Riprap length /
�
,
-(-
- t—
Avg distance offshore
,'
Breakwater/Sill_
--
—
-
Max distance/ length -
Basin, channel
"-�-
-
-
—
—
'-
t
Cubic yards
Y
—
Boat ramp
-i
"I
Boathouse/ Boatlik
Beach Bulldozing
-_ I
Other
I
i
sAV observed: yes no
Moratorium: n/a yes no
Site Photos:
,
S 1�
yes no
---..
'
__.
_...,_
" .'
_
F
Riparian Waiver Attached:
P Yes no
�
_..__
.
_
r..T—
,
-'-
_
_
_.
i
A building permit/zoning permit may be required
Permit Conditions'i
Agent or Applicant PRINTED Name
TAR/PAM/NEUSE/BUFFER(circle one)
j I , - I , } ❑ See note on back regarding River Basin rules
J
AT APPLY TO THIS PROJEI
Signature '*Please read compliance statement on back of permit"
App ication Fee(s) Check q/Money Order
❑ See additional notes/conditions on back
(Please Initial)
Permit Officer's PRINTED Name J
zu
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit -p�,� 7 S f t ph cr o, e 141 <(,� 5
Mailing Address. X; l _..I W o of c 1 r D t-
Lmf r 6 :TSl-e ,k) C- s�2c
Phone Number: tom- 2 (>
Email Address: (a t GICS a c i k Y 1 P�
certify that I have authorized C oQ0 *b EuCkSI forGCS at"cf �Sea u1 C�I I S
Agent I Contractor
to act on my behalf for the purpose of applying for and obtaining all CAMA permits
r i
necessary for the following proposed development J _x is t— n�er P, Pi—
at try property located at ��' Irl �1�t�Ct�G1� 4 _ wuj-'zt fd �JG
,n _cal-k- _f -County.
! 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
� J RFCFIVE[�
eau G 'I / *
Signet ure �— '
MAY 0 S3
Print or Type .Name DCM-MHf<D CITY
Date
`his certification is valid through . !_. ____J

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
iTop portion to be completed by owner or their agent)
Name of Property Owner. _:D11Y l f�la'1 '(� 14 (c F S 6�t�
Address of Property j -I Wood - 'C4 L> i ne 1,04 / q11C N C_ [� t
Mailing Address of Owner _ r >I �1 �ti' U Lt G r `. i'1' .S'tt-iL% S-�jl��N �-i$
Owner's email i l C(C s 2G3 ( aN,,V_f Owner's Phone#
Agent's Name.
Agent's Email
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
!Bottom portion to be completed by the Adiacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing, with dirnensrons must be provided with this 'etter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you haW objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at (252) 5t5-5400, No response is considered the same as no objection if you have been notified by
Certified Mail,
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater; boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
DO wish to waive some/all of the 15' setback l�
OR Signature of Adja of Riparian perty Owner Rr-:CFlVE[)
do not wish to waive the 15 setback requirement (initial the blank)
% MAY © 11 %flI
Signature of Adjacent Riparian Property Owner i1,t.r&LJ DCM--MHO Cl"PY
TypedlPrinted name of ARPO c ® Cvee_
Mailing Address of ARPO: '22,!! a I 'ea".'o �-_
ARPO's email: CG,osg�'��jrJ�, ;; ' ARPO's Phone#:
Date: g 2O '. 'waiver is valid for up to one year from ARPO's Signature`
Revised May 2021

k
l �
i
RECEIVED
MAY 0 0" 20?3
DCM-MHD CITY

WCt-0MA / ❑ DREDGE & Ftg.P_ A B �C;) D
GENERAL PERMET Previous permit#
Wew ❑Modification OComplete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources _-�j t f
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / f7 .
% _ FFrK, es attached.
Applicant Name _V �j`/V'f'n _�/� 11� ��4✓U+'_t�/',�t 'y , Y(t`fcjProject Location: County_C.,:t=`z
Address ffrf t/ r-YG(-"i•"' �T Street Address/State Road/ Lot #(a)/
City t✓V�rf"1 ., _State_�G ZIP y _
{�t
Phone# s`z-)(,y{�"Jfj!E-Mail _ ...—__ Subdivision /�
Authorized Agent _ 6't %C ct'l ' � _ Gt)l . rl CY'G � t_i1.. - '/ e 71P
Affected OCW �(FW ROTA ❑ /ES ❑PTS Phone # (_) River Basin f ,14,L, E,
❑OEA ❑ HHF 01H 0 UBA O N/A
AEC(s): Adj. Wtr.Body /,-''�.;t, :�4r✓r:d"' r,2ar man nnkj
ORW: y r Closest Mal. Wtr. Body--!.�.�.�.-gta✓+a
es no PNA yes
Type of Project/ Activity !{ /
/ r �
Pier(dock) length
Fixed Pimform(s)__„__I' —�-
i
Finger pier(s),,�_7_L8
Groin length
number__
Bulkhead/ itipmp length
avg distance offshore
max distance offshor
Basin, channel
cubic yards
Boat ramp
Xil i
t.
_._7
i
Beach sulk.'oang
Other_
Shoreline Length—Alft171! -
SAV: not sure (yes? no I
�._J t
_._
Moratonum'. nta yes
Photos: yes irk
Waiver J lAttached: yes (_ ' t_..__J._..
A building permit may be regquiired by: Z'f yl CYO
(Now Local Planning furisdictio
"4
Notes! Spedai Conditions / / Li[� IVjC f'C'�J rt' t�i .S (� (_-z
r !r
bt' I'q 4<, 'd at, {A Cu Lf'9rc 4.n 4,
Agent or Appikttlt 'am'" /�J Printr_ed-_Nr"am-.e-.'' � ) "�,"`_"__' }-- r�H^_'Y Y�i©9ks•`9C3r
S_RGY_iPtOfjj /ejjrsPjt/i1r1il ceame
SignerePiepjleadcompliancestatementonbackofa"
r" 0��
Appiicatlonfee(s)
check 9. ati n

Davis, Elena L
From: Don Hicks <[e-mail]>
Sent: Tuesday, May 2, 2023 11:43 AM
To: Davis, Elena L
Subject: [External] Re: CAMA Packet
Attachments: HPSCAN_20230502152153979_2023-05-02_152241225.pdf; HPSCAN_
20230502152308296_2023-05-02_152356085.pdf;HPSCAN_20230502152431629_
2023-05-02_152519349.pdf; HPSCAN 20230502152604441_2023-05-02_152653625.pdf
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Ms. Davis,
Per our conversation, please see the attached documents:
- Agent authorization for LAMA permit application
- Drawing of project
- Adjacent Riparian Property Owner Certification of Approval.
- Original permit from 2016
Please contact us if you have any questions.
Thank you,
Don and Stephanie Hicks
336-213-4289
[e-mail]
Sent from AT&T Yahoo Mail on Android
On Mon, Apr 24, 2023 at 10:11 AM, Davis, Elena L
<[e-mail]> wrote:
Attached is the general permit packet, and below is your field rep's information.
Have a great day!
DCNI Field Representative
Field Rep
DCM Office
Phone
Kara Guthrie
Morehead City Regional Office
252-515-5421

Cell Phone [phone]
Email k-ora.euthrieCancdenr.e
Elena Davis
Administrative Assistant
Division of Coastal Management
Department of Environmental Quality
252.515.5400
252.515.5401 Fax
Elena. Davis@ ncdenr.gov
400 Commerce Ave
Morehead City, NC 28557
Noehirig Compares _.,,...
tiCi!'ztli i;FJ'N]I. IPn.
Qepadment of Environmental Quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
Click HERE to Find the DCM Field Rep in your CAMA region
2

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVFR
(Top portion to be completed by owner for their agent)
Name of Property OwnerGn 2 P Vx cc rt i 2 Iy I C k S
Address of Propeny: 7�51 � �GOdG� � �� �r. VVI p and cf TS L*, k �)95 14
Mailing Address of Own,- I/7GlYY1(ir1
Owner's email: h Ta 1 d S 0,e49-ne-r0wner•s Phone#: 35 b `213--gP-rl
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIMCATM"
Rottom portion to be completed by the Adjacent Property Owner)
1 rhereov certify that i own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
I DO NOT have objections to this proposal. I DO have objections to this proposal.
Of you nave objections to what is being proposed, you must notify the N.C. Division of Coastai
Management (DCM) in writing within 10 days or receipt of this notice. GDIreSDonaence snoura De
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAtvER SECTION
1 understand that anv proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, iiii, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must siar,
the appropriate blanM 'uu;uw,
. UO wish to waive some/all of the 15' setback��/�,
2k�,�OL_4 rvt'—'�t I t cZl
Signature W Adjacent Riparian Property Owner
do not wish to waive the 15' setback reauirement (initial the blank)
Signature of Adjacent Riparian Property Owner
TvneriiPrinied name of ARP(•.
Mailing Address ofARPO: `�� �� o��� \" EY ���c )k4c
ARPO's email: ARPO's Phone#: `��•^� ��� 't�� 5
Date: S��s��'� 3 *waiver is valid for up to one year from ARPO's Signature'
RECEIVED
Revised Mav 2021
MAY 15 2023
DCM-MHD CITY

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DEL11/Fn`
(Top portion to be completed by owner or their agent)
Name of Pronertv OwnerGn
Address ofPropeny: '95I"1 VVi50&-1J -f T>Y.1r'MPVyAd r�e hiC MKSI
Mailing Address of Oki^--.:
Owner's email: � l4sgiba e), Owners Phone#:
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIAN oonocoT nWNFR'e CrRTIFICA,Tht�
!3ottom portion to be completed by the Adjacent Property Owners
I nerebv certify that I own property adjacent to the above referenced property. The individuai applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
tlescriotion or drawing, with dimensions. must be oroylded With this letter.
t� I DO NOT have objections to this proposal. I DO have objections to this proposal.
It you nave objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days or receipt of this notice. Correspondence should oe
malted to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that anv proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, iin, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sig„
the appropriate bla1,lK
DO wish to Waive some/all of the 15' setoacK q\ C
Signature of Adjac t Riparian Property Owner
OR -
do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owne- / K art�c-c f� C /r `
TypediPrinted name of ARPC,• `
VIAAY'Q a V- e-t - f N t4 1
Mailing Address of ARPO: 9 y rLI r 11 2 v, itd • �o N
C61k
ARPO's email: Y5! it,W-1, LL Ci Ad J ARPO's Phone#:
Date: A *waiver is valid for up to one year from ARPO's Signature'
RevisEdaYAD
MAY 15
DCM-MHD CITY

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or �their agent)
Name of Property Owner: �iia t ��� ( �'1 'f� 141 C
Address of Property: S I 1 V g 6LOC I . -C 4 Wl e �� 1 cj �S�f , N G-
Mailing Address of Owner 'S61-7 WDCAC-l' E�T> - Ell PF aV r IP NC
Owner's email: At C( �fi & QIt,,let Owner's Phone# J 5� 113-4420
Agent's Name:
Agent's Email:
Agent Phone#:
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawing, with dimensions, must be provided with this letter.
V I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign
the appropriate blank below.)
100 wish to waive some/all of the 15' setback 7J/J,
��i Q,<'iw M ` cLw
Signature of Adja n ian perty Owner
-OR-
i do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: t1461 J
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO'sLLe�'mail: �p�,1ri4)e6-o `''A PO's Phone#: /
Date: "T g o2O ' 'waiver is valid for up to one year from ARPO's Signature'
Revise�ftg`NtD
MAY 15 2023
DCM-MHD CITY

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVFR.4'
(Top portion to be completed by owner or their agent)
Name of Pronerty Owner _ 1)6n � 5+e arx I C k s
Address of Property: T>Y i c M e yat Gll r�IP) ISC D859tt
Mailing Address ofO;cr.,.. SGtrr1e-,
Owner's email: /GKsy 02@ nR r Owners Phone#: 33(p-213- 10�rq
Agent's Name:
Agents tmail:
Agent
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATIOV
(3ottom Portion to be completed by the Adjacent Property Owner)
I nerebv certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or arawma. with dimensions must be provided with tnis latter.
I DO NOT have objections to this proposal. I DO have objections to this proposal.
if you have objections to what fs befog proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt or this nonce. Gorresoonaence snouia oe
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that anv proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sic.-,
the appropriate blar,k
. DO wish to waive some/all of the 15' setback ( I
Signature of Adjacent Riparian r perry Owner
nR_
e do not wish to waive the 15' setback reauirement (initial the blank)
Signature of Adjacent Riparian Property Owner
TypediPrinted name of ARP(-: .L�6,-eo T7^i`-( /l 6= '>T _
Mailing Address ofARPO: 9-nD-0 Locw>d_xvjF
ARPO's emaii: U t-e-r,t:-)•),�J•h • /. '{ARPO's Phone#: 32;`i'77e,`d7
Date: J /`a .2 —*waiver is valid for up to one year from ARPO's Signature'
Revised Mav 2021
RECEIVED
MAY 15 2 ;
DCM-MHD CITY

0
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVER"
(Top portion to be completed by owner or their agent)
Name of Property Owner: T-) C,, � V e pk cl ✓tie 14 1 C I S
Address of Property. 1517 1(000tAdJ-f Dr. "ime y-W el TsA&. lk 28S,4
Mailing AddressofOemer: SQYyI �
Owner's email: J )e✓ (4zo ® t1kru--t- Owner's Phone#:
Agent's Name:
Agent's Email:
Agent
ADJACENT RIPARIA`! PROPERTY, OWNIER'g CERTIFICATIOII'
{'Aottom portion to be completed by the Adiacent Property Owner)
I nerebv certify that t own property adjacent to the above referenced property. The individual applying for this
permit he/described to me, as shown on the attached drawing, the development they are proposing. A
I DO NOT have objections to this proposal. I DO have objections to this proposal.
it you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 70 days or receipt or this nonce, corresoondence snouto ix
mailed to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. No response is considered the same as no objection if you have been notified by
Certified Mai!.
WAIVER SECTION
1 understand that anv proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15' from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). If wish to waive the setback, you must sign
„he appropriate blank
00 wish to waive some/all of the 15' setback
r)R-
, do not wish to waive the 15' setback reouirement
Signature of Adjacent Riparian
TypediPrinted name of ARPll:
Mailing Address of ARPO: / 7(p /7UG/j/lOUjC /1U/rGf, J/vt/t/lr ,/VX -Vt I r
ARPO's emaii:J �'t/UMl of ! ARPO's Phone#: L7�j ��Q �
/h,4��. C0Al
Date:. 'waiver valid or up to one year from ARPO's Signature`rr��� FFl�yy
Revi�'see foal vy;P,
MAY 15 2'_s
DCM-MHD CITY