HomeMy WebLinkAbout91241C - Earp i
,o1e"14 D;kCAMA ❑ DREDGE & FILL Na 91241 A B O D
GENERAL PERMIT Previous permit
�• Date previous permit issued ----'
%New [-I Modification ❑Complete Reissue LJ Partial Reissue
As authorized by the State of North Carolina,Department of EnvironniwAl Quaaty and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC b7 H 1G0 _ C Rules attached. General Permit Rules available at the following link:www.deq.nc gov/CAMArules
Applicant Name V1 KKs S. Eh RP _.,_- Authorized Agent. �o PFL (�NSfl-L-cri alp(
Address-Tq--09 Rgf.Aot�AgA1i DR _ Project Location(County):- 0/115L036/
City &LE11161I State 1(4c_ --ZIP��12_ Street AddressrState Road/Lot#(s) _174 616 HAMMU CX foot ' RD
Phone M(V) Vs-lilIe ---- —
Email_y1�(k s CO►c _0.rv+s i I.Cn M _.- Subdivision
city SNEAbs JaW ZIP 2946b
AHacted NCW gEW JKPTA ❑ES ❑PTS Adj.Wtr.Body /QI" -___ _ (nat/man m
AEC(s): U OEA ❑IHA ❑UW n SPIMA ❑PWS Closest Mal.Wtr.Body-. A E w �, V F K
ORW:yesO PNA: es no
Type of Projed/Activity PVrra0611 0 i C' ' vr6�ti��'��"�f . �,'n.,f� Di Ve, a.1
IF (Scale: ,(`r5)
Shoreline length�QQ, ��� _
Access length -r
fir - *- -_- -i-_I-' ` —AS
ke
Pier(dock)length t �1; J.` J� -
��i i
Fixed Platforms) 1L /xill -
Floating Plallorm(s) er'
Fingtrpier(s) Y /X 12 - -' - - - -
Total Platform area �
/P
Grain length/tt �t 1ItU✓iA "1-- -- 1-)--�- _,-- - - -- - -/�� f
Bulkhead/Riprdp length
Av distance offshore
6
Breakwater/Sill ' � i— - � "' �- i - '- "4- 1
Max distance/length )s - - 1- ,f - e ✓ "`- _ - " ("' "T -
Basin,channel ` S - -
Cubic yards
Boat ramp 1
Boathouse/Boatlift -41
ft
Beach Bulldozing -�- -�— _ I _ --,71
Other S� j an# - ' _ _
SAV observed yes -
Moratorium: n/a yes r�✓,rl�•" �- -� - -,.. - -t_ '- - 4- - - - -�
Site Photos: yes �n✓ 1 J-L._._ _-�_ J` '� —r_ _ 1- - - --�- - �N�! w4
Ripanan Waiver Attached: & no t i ihJ• ` __ _-_ __i_ �_- _.L_ _�-_ _ _�- _. __-
A building permit/coning permit may be required by
Permit Conditions I? kdf I• /_ ��a I,�f�,eei 8 1 -'� ❑TAR/PAM/NEUSE/BUFFER(circle one)
ri; a W."ti ri
1 i; v o ' OF _ Q v e _4 l a w 4 3_ See note on back regarding River Basin rules
r►1 i h r sM M�t � vi v P
See additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
JO 1 ✓ --- aiy4a✓ 4z J C -
�1 f
Agent or A PRINTED Name Permit Officer's PRINTED Name
Si nature--Please read compliance statement on back of permit•' Signatur
0 V 00% 3fos� P�, '�o •Z 1 a/ �/ �
Application Fee(s) Check M/Money Order Issuing Date Expiration Date
`°"Sr", D�CAMA ❑ DREDGE & FILL No 91241 A B Q 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 07 H -I'�00 ❑Rules attached. JK General Permit Rules available at the following link:www.deq.nc.gov/CAMArules
Applicant Name V1 KK% S. CARP Authorized Agent -AcSH l�At�BCK / PFL Catismtc-Tiom
Address 11401 14A'KZOVAGATE CDR Project Location(County): ONSLOy�/
City 9AUS1614 State IY C., ZIP �761:2 Street Address/State Road/Lot#(s) 174 Sm NAMMoc.K Poor RD
Phone#O
Email goa p AC gpa'.1.to rv1 Subdivision
City SNEAbs FFKRy zip 28'iGa
Affected CW :4EW PTA ❑ES ❑PTS Adj.Wtr.Body A I W W (nat/manq
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body A I w W -N E w R 1 V E K
ORW:yes no PNA: es no
Type of Project/Activity pea/ o5e 0 i t v� ��`="'�`"�t ��'h A�✓ DI L'y a�I d /✓/S f ✓w+
(Scale: /I r5)
Shoreline Length � /�'
Access Length — a \ i -hl k
Pier(dock)length S X :l f1m \/' ✓ OSC� A)t'^j
7r r i
Fixed Platform(s) �� Xa`CJ f �5 &t1 4
FloatingPlatform(s) I � 'f/ /2� n�@'
Finger pier(s) V !x 12" ,
I
lA
Total Platform area
.<F
Lv�wCk S
Groin length/# — pty.
Bulkhead/Riprap length 11/ lyff���
Avg distance offshore
W
Breakwater/Sill
Max distance/length _ ' S�fC GEC `�''/ /
Basin,channel err 5 XA/2 5 K
Cubic yards — Y✓ /�� (5�Sr c"
Boat ramp i
( � �J v
Boathouse/Boatlift ''
Beach Bulldozing
Other ltG
V �
SAV observed: yes
Moratorium: n/a yes rv,✓�I�''' 6c>
Site Photos: yes
J
Riparian Waiver Attached: & no i�,ti/`�C al Vr•J�
A building permit/zoning permit may be required by: 0 In Ia.-, Gh✓1 } 1
Permit Conditions To in --rti � goo
❑TAR/PAM/NEUSE/BUFFER(circle one)
Cal fT• 25 v 0 �✓ o vQ✓ p q I� A-l A l- 1\ I Lk p ❑ See note on back regarding River Basin rules
aiI�OVC
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Q i aka ✓� /4,-- vv►C y
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature"Please read compliance statement on back of permit" Signatur
y oo=
Application Feels) Check#/Money Order Issuing Date Expiration Date
Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
1-1 Tar- Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: 252-247-3330 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax:252-948-0478
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:910-395-3964
(Serves: Bertie,Camden,Chowan,Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021
❑CAMA EDREDGE & FILL N9 91241 A B C) D
3 Previous ermit
GENERAL PERMIT p -t
Date previous permit issued
❑New ❑Modification [J 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 0'7 H i,�� ❑Rules attached. E] General Permit Rules available at the following link:www.dgq.nc.gov/CAMArules
Applicant Name J+K K+ �?. G A F f Authorized Agent —0SI-1 GG- 5iL t j 17rL i,)r)STFUCT 1oN
Address `I yG9 )4AV ZUU4GA'1f Dr'r, Project Location(County): -"J Luy.
City 1-,'ALA+<.H State IV L zip %Irl Street Address/State Road/Lot#(s) 1741 )i16 tJAMMo� K 1)o,NT �P
Phone#(_Ul ) 313-7`JI6
Email V XK<, P.�L c OLa P.Ick i r+n Subdivision
City ': ►yEAD5 FL9,Fy ZIP .?941ob
Affected ®CW rgEW g PTA ❑ES ❑PTS Adj.Wtr.Body A I V/ W (nat/ nl
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWs Closest Maj.Wtr.Body A I w M/ -N�- w f:1 V E K
ORW:yes/no` PNA:yes no
Type of Project/Activity
(Scale: /' )
Shoreline Length /''
Access Length
Pier(dock)length 5�x '
✓ II I ,i
Fixed Platform(s) S
c✓
�f
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/Riprap length ^ i - All-
1 - __ _.
Avg distance offshore
Breakwater/Sill
Max distance/length 7d
Basin,channel
Cubic yards
oe
Boat ramp - - - - -
Boathouse/Boatlift
Beach Bulldozing
Other
t- 1111
.
SAV observed: yes
Moratorium: n/a yes
A
Site Photos: yes no
Riparian Waiver Attached: yes• no f" q VL
A building permit/zoning permit may be required by: Gw �Gh r1 r
Permit Conditions } /L c �1 ��a '' ❑TAR/PAM/NEUSE/BUFFER(circle one)
i 'L r v ^✓' � �II ❑ See note on back regarding River Basin rules
14 Co
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
1 c h L. ✓� i2� ,c �OJ'iC y
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature"Please read compliance statement on back of permit" Signature
Application Feels) Check#/Money Order Issuing Date Expiration Date
Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
1-1 Tar- Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax: 252-247-3330 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River, Onslow Fax: 252-948-0478
Counties) (Serves: Beaufort, Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S. Griffin St.Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: 910-395-3964
(Serves: Bertie, Camden,Chowan, Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021
�1*�jt°"4,&I OCAMA ElDREDGE & FILL N9 91241 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:www.deq.nc.Yov/CAMArules
Applicant Name _ • c. Authorized Agent L ; / _.,.v'yT '• c? V
Address "' A— \'E Df, Project Location(County): 4
City •,.ALE+ -4 State L ZIP %L,1.2 Street Address/State Road/Lot#(s) I :'ci
Phone#O
Email Subdivision
City FL;,r,.Y ZIP '`tl t U
Affected E CW EJEW ❑PTA ❑ES ❑PTS Adj.Wtr.Body h.f J/✓ (nat/man/un
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PWS Closest Maj.Wtr.Body n 1 W VV ''N�� Vy P,1 V& I
ORW:yes/nod PNA:yes%no
Type of Project/Activity
(Scale:����
Shoreline Length
Access Length j
Pier(dock)length i
Fixed Platform(s) f' j
Floating Platform(s)
r
4-
Finger pier(s) E
i
n
r ,
Total Platform area '
Groinlength/#
Bulkhead/Riprap length
Avg distance offshore --
-
Breakwater/Sill
f✓
Max distance/length
Basin,channel
Cubic yards
Boat ramp E
Boathouse/Boatlift
Beach Bulldozing
Other
SAV observed: yes no !
Moratorium: n/a yes no
Site Photos: yes no j +
Riparian Waiver Attached: ye>1 no ✓idr
A building permit/zoning permit may be required by!
Permit Conditions IUd ❑TAR/PAM/NEUSE/BUFFER(circle one)
�1 ❑ See note on back regarding River Basin rules
f •- GU�
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
Signature"Please read compliance statement on back of permit" Signature
Application Fee(s) Check#/Money Order Issuing Date Expiration Date
Statement of Compliance and Consistency
This permit is subject to compliance with this application and permit conditions. Any violation of these terms may
subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for
compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
F-1 Tar- Pamlico River Basin Buffer Rules F-1 Neuse River Basin Buffer Rules
If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the
Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
Notes/Additional Permit Conditions:
Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
project area and disposed of in an appropriate upland location.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889
252-808-2808/1-888-4RCOAST Fax:252-247-3330 252-946-6481
(Serves:Carteret,Craven—south of the Neuse River,Onslow Fax:252-948-0478
Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Elizabeth City District Wilmington District
401 S.Griffin St.Ste. 300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax:910-395-3964
(Serves: Bertie,Camden,Chowan,Currituck,Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties)
Pasquotank and Perquimans Counties)
http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021
AGENT AUTHORIZATION FOR C1=.MA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 41.yw
Mailing Address: 'T o
�aJew' k
Phone Number: g I g J`r 67/4
Email Address: V i kki, .rn,4 i�--r C411
certify that I have authorized PE ��1 L-La,54 !
Agent/Contract r
to act on my behalf, for the purpose of applying for and obtaining all,CAMA permits
A
necessary for the following proposed development: IbA6Z.,ee"
at my property located at
in �Jr O L-° County. / ►� (� O
l 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.
2A, ia,
Si nat
VIK p-
Print or Type Name
Title
Date
This certification is valid through
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: Vicki Earp
Address of Property: 174 Big Hammock Point Road
Mailing Address of Owner 4409 HARBOURGATE Dr. Raleigh, NC 27612
Owner's email: Owner's Phone#: _
Agent's Name: Josh Barber/PFL Construction Agent Phone#:910-330-5569
Agent's Email: pflmarine@gmail.com
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property Owner)
1 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
4escrf�tion or drawing with dimensions. must be provided with this letter.
__ I DO NOT have objections to this proposal. I DO have objections to this proposal,
ou have ob
if y jections 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)808-2808. 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 Sinn
the appropriate blank below.`
I DO wish to waive some/all of the 15'setback
-OR-
Signature of Adjacent Riparian Property Owner
I do not wish to waive the 15'setback requirement(initial the blank)
Signature of Adjacent Riparian Property Owner-_
Typed/Printed name of ARPOf:� ll;,e>1"y%=W'--
Mailing Address of ARPO: "/` '�-4( a.�►{;,�s� L4,4 Q
-1 4
ARPO's email: 1ho Itifh ,r-e.✓ x,,ARPO's Phone#: (Z
Date: "waiver is valid for up to one year from ARPO's Signature*
Revised May 2021
N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: Vicki Earp
Address of Property: 174 Big Hammock Point Road
Mailing Address of Owner: 4409 HARBOURGATE Dr. Raleigh, NC 27612
Owner's email: �,YaJj+ kI LOwner's Phone#: `l'/1-
I ic-J I,I
Agent's Name: Josh Barber/PFL Construction Agent Phone#:910-330-5569
Agent's Email: pflmarine@gmail.com
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.
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(252) 808-2808. 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.)
I DO wish to waive some/all of the 15'setback
Signature of Adjacent Riparian Property Owner
-OR-
I do not wish to waive the 15'setback requirement (initial the blank)
Signature of Adjacent Riparian Property Ownerx ytL�_
Typed/Printed name of ARPO: Ple tti f� )O
Mailing Address of ARPO: I�� T�1 4 UZAe4�
ARPO's email: I'1U0X1Z a ) ARPO's Phone#:
Date: J �d 'waiver is valid for up to one year from ARPO's Signature'
Revised May 2021
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