20040026 Ver 1_401 Application_20040109

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January 8, 2004 RICE &
ASSOCIATES
Division of Water Quality
401 /Wetlands Unit
1650 Mail Service Center
Raleigh, North Carolina 27699-1650
Re: Preconstruction Notification Application
Cedar Ridge Subdivision (R&A Project #: 03-024)
Rolesville, Wake County, North Carolina
Dear 401 /Wetlands Unit:
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Rice & Associates is submitting the following Preconstruction Notification (PCN) Application for the above-
referenced project in parallel with request for US Army Corps of Engineers (USAGE) approval of Nationwide
Permit Number 12, Section 404 Permit and North Carolina Division of Water Quality (DWQ) 401 Water
Quality Certification and Watershed Buffer Rules Certification.
Written approval is requested for 401 Certification of 77.5 lineal feet cumulative impact to streams and
19,760 sf of cumulative buffer impacts. Attached is the PCN Application and additional documentation
listed below.
The project will include subdivision streets, water lines, sewer lines, and storm drain facilities for Phase 1
of asingle-family subdivision named Cedar Ridge.
The following additional documentation is being provided with each of the seven (7) copies of the PCN
Application:
1. A copy of the cover letter addressed to the USAGE for 404 and NWP 12 approval.
2. A set of 1 1 "x17" impact exhibits
3. Signed and dated copies of the "Agent Authorization Letter'.
4. A $200.00 check for the review fee.
5. A Neuse River Basin Riparian Buffer Rules (NBR 03-0131) letter dated June 23, 2003 with attached
soils and quad maps.
If you should have questions or require additional clarification during the review please feel free to contact
me at (919) 854-081 1, extension 105.
Very truly yours,
RICE & ASSOCIATES
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Cameron M: Rice, P.E.
cc: Bob Polanco (w/ attachments)
978 Trinity Road Raleigh, North farolina 27607 Voice 919.854.0811 Fax [phone] Email: [e-mail]

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ASSOCIATES
January 8, 2003
US Army Corps of Engineers
Wilmington District -Raleigh Regulatory Field Office
6508 Falls of Neuse Road
Suite 120
Raleigh, North Carolina 27615
Re: Preconstruction Notification Application
Cedar Ridge Subdivision (R&A Project #: 03-024)
Rolesville, Wake County, North Carolina
Rice & Associates is submitting a Preconstruction Notification (PCN) Application for the above-
referenced project with request for US Army Corps of Engineers (USAGE) written approval of a
Nationwide Permit Number 12 and a Section 404 Certification. Seven copies of this submittal are
being provided in parallel to DWQ for 401 Water Quality Certification and Watershed Buffer Rules
Certification.
The project will include subdivision streets, water lines, sewer- lines, and storm drain facilities for Phase
1 of asingle-family subdivision named Cedar Ridge.
The enclosed PCN Application and attached additional documentation listed below should provide the
necessary information required to secure Section 404 Certification for the stream crossings.
1. A set of 1 1 "xl 7" impact exhibits
2. Signed and dated copies of the "Agent Authorization Letter'.
3. A Neuse River Basin Riparian Buffer Rules (NBR 03-0131) letter dated June 23, 2003 with
attached soils and quad maps.
If you should have questions or require additional clarification during the review please feel free to
contact me at (919) 854-081 1, extension 105.
Very truly yours,
RICE & ASSOCIATES
~~ 4
Cameron M. Rice, P.E.
cc: Bob Polanco (w/ attachments)
978 Trinity Road Raleigh, North Carolina 27607 Voice 919.854.0811 fox 919.854.0812 Email: [e-mail]

Dec 15 03 09:O1a BAH POLRhIrO
ift~.-12-2003 02.30 PM R t ce & gssoc 1 aL es
(9191 786-1314 p.l
9298340812 P. 02
03-024
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RICE ~
AS50(WiES
December 9, 2003
US Army Corps of Engineers
Wilmington District -Raleigh Regulatory Field Office
6S0$ Foils of Neuse Rood
Suite 120
Raleigh, North Carol;no 276 ~ 5
Re: US Army Corps of Engineers
Agent Authorization Letter
Cedar Ridge Subdivision
Rolesvi[le, Woke County, North Carojina
The undersigned hereby authorizes Rice $ Associates to proceed on behalf of the
current property owner as the agent #or wetland permitting issues artid applying for o
preconstruction notification for the above referenced project site.
Sincerely,
R[C£ 8 ASSOCIATES
C~-.~,~(
Cameron M, Rice, P.E.
$ob Polonco _
(current property owner or authorized agent)
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12/17/2003 15:43 FA%
X002
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Aran W. KHrnak, P.E. Director
Division of Water Qualibr
June 23, 2003
Laura Gadd
S & E C, Inc.
11010 Raven Ridge Road
Raleigh, N.C. 27614
Dear Ms. Gadd:
Subject- Neuse River Bash Riparian Buffer Rules
NBR 03-131
Tillett Development
Project No. 03-t;tf~@' G 1~t2. a 1
Wake County
An evaluation of the stream features present on the property was pertormed on May 28, 2003 to
determine whether or not the site would require oampliance with the Neuse Buffer Rules. Phis
site is referenced as 030131.
The features represented on the Wake County Soils and the Rol®sville USGS topographic maps
were evaluated to determine their subjectivity Eo the Rule. There are four stream features and
three ponds n~presented on the maps far this property. Four unnamed tnbutarfes and the each of
the ponds are subject to the Neuse River Bash: Nutrient Sensitive Waters Management Strategy;
protection and Maintenance of Existing Riparian Areas, Administrative Code 15A:208.0233.
One additional feature labeled as E is indicated on the soil map but is not present on the ground
as streams and are not subject to buffer protection. (See attached map}.
This letter addresses only those issues involving the riparian area. For information relative to
other impacts, 401/404, or wetland issues, please contact Mr. John Domey at 919-733-1786.
Thank you for your attention tv this matter and if this pffice can be of arty other assistance or if
you have additional qu4estfons, pl®ase do not hesitate to contact me at 919-571-4700.
Sincerely,
cc; RRO/John Dorney
Wake County
Land Quality
H:lbuflet.for14uf03\tillett. l 31
Steve Mitchell
Environments( Scientist
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water Qu~iry Section ~ Raleigh, NC 27689.1828 f2CSknile {919) 5714718 1-80023-7748
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RQI.~SVILLE, NC
`l~ 1993
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NiMA 5355 IV~I~TiV-SERIES V842
Project #: Scale:
Soil & Environmental Consultants, PA
~~'01 '~ - ~ Figure 1- USGS Quad •
y`9 ~ ~~ Roiesvlile Road ~ 11010 Raven Ridge Rd.• Raleigh, NC 27614
T'rtlett Development (919) 846-5~0 • [phone]
Rolesviile, Wake County, NC Web page: www.SandEC:com

Project #: Scale:
~~01 'n ~'~ Figure 2 -Soil Survey
Project
Mgr.: TP Date:
4!7!102 ROlesvjlle Road

7i#lett Development
RolesviUe, Wake County, ~
Soil & Environmental Consultants, PA
11010 Raven Ridge Rd.• R~eigh, fJC 27614
(919) g46-5900 • [phone]
Web page: www.SandEC.co-n

Offlce USe Orily: Form Version May 2002
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ^ Riparian or Watershed Buffer Rules
^ Section 10 Permit ^ Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 12
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ^ N/A
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ^ N/A
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ^ N/A
II. Applicant Information
1. Owner/Applicant Information
Name: Prominence Homes
Mailing Address: 8804 Albright Road
Raleigh North Carolina 27612
Telephone Number: 919.786.1314 Fax Number: 919.786.1314
E-mail Address: not available
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: Rice & Associates
Company Affiliation: Agent
Mailing Address: 978 Trinity Road
Raleigh, North Carolina 27607
Telephone Number: 919.854.0811 Fax Number: 919.854.0812
E-mail Address: smr riceassociates.net
Page 5 of 13

III. Project Information
8.
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Cedar Ridge Subdivision
2. T.I.P. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): 1768.05 18 6127
4. Location: South of Rolesville in Wake County
County: Wake Nearest Town: Rolesville
Subdivision name (include phase/lot number): Cedar Ridge Subdivision
Directions to site (include road numbers, landmarks, etc.): From downtown Rolesville qo
south on East Young Street (SR 1003~for 3/4 of a mile and the site will be on the
right across from New Bethel Baptist Church.
5. Site coordinates, if available (LTTM or Lat/Long): Not Available
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 102.34 Acres
7. Nearest body of water (stream/river/sound/ocean/lake): UT to Harris Creek
River Basin: Neuse
(Note -this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: The existing conditions on the site include numerous
tributaries, three (3 farm ponds, wetlands Neuse River Basin Buffers, large rock
outcrops shallow rock, and mountainous terrain. The surrounding uses to the
Page 6 of 13

North- and South are vacant, public right-of-way to the East, and asingle-family
subdivision to the west that is currently under construction.
10. Describe the overall project in detail, including the type of equipment to be used: The
overall project will include subdivision streets, waterlines, sewer lines, and storm
drain facilities for Phase 1 of a single familysubdivision.
Explain the purpose of the proposed work: The purpose is to provide the market with a
guality single-family subdivision in Rolesville.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, ,application date, and date permits and
certifications were issued or withdrawn.. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Soil & Environmental Consultants PA submitted to DWQ a buffer determination for a
project named Tillett Development (NBR 03-131, Proj.# 03-6892.01). Attached is a
copy of the letter from Steve Mitchell.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
Yes. The anticipated work includes roadway stream crossings. The exclusion from
the current application is for a number of reasons. The project has to be phase due
to the number of water permits allowed, developer cost,. and erosion control
reaulations.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
Page 7 of 13

mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Provide a written description of the proposed impacts: Three ~ .perpendicular sanitary
sewer crossings of a Neuse Buffer stream
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
(acres Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http:/hvww.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 0.29 acres
Total area of wetland impact proposed: 0 acres
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on ma)
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Im act Perennial or
Intermittent?
(leases ecif )
SISN 101 Sewer 26.5 UT to Harris Creek 3 Perennial
SISN 102 Sewer 30.8 UT to Harris Creek 3 Perennial
SISN 103 Sewer 20.2 UT to Harris Creek 3 Perennial

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several Internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.ma~quest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 77.5 LF
Page 8 of 13

4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact

Site Number
(indicate on ma

Type of Impact* Area of

Impact
(acres)
Name of Waterbody
(if applicable) Type of Waterbody

(lake, pond, estuary, sound,
bay, ocean, etc.)
N/A

* List each impact separately and identify temporary impacts. Impacts .include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ^ uplands ^ stream ^ wetlands
Describe the method of construction (e.g., darn/embankment, excavation, installation of
draw-down valve or spillway, etc.): n/a
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): alternate design to a level spreader to provide
diffused flow and allow direct discharge to the existing pond through the buffer.
Size of watershed draining to pond: 7.4 acres Expected pond surface area: 0 sf
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It maybe useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options -were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
To minimize impacts to existing streams an environmentally friendly route for the
sewer was taken. All sewer easements were located outside the Neuse River Basin
Buffer or confined within Zone 2 for the entire alignment with the only impacts to
Zone 1 occurring at the perpendicular stream crossings. Site constraints includes
numerous tributaries to Harris Creek, three farms ponds, wetlands, Neuse River
Basin Buffers large rock outcrops, shallow rock, mountainous terrain, only one
existing sewer manhole to connect to and Rolesville requiring sewer stub-out to
adjacent properties for future connection.
Page 9 of 13

VIII. Mitigation
DWQ - h1 accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o. enr. state.nc. us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Wetland mitigation is not required since we are not impacting any wetlands.
Stream .mitigation is not required since impacts to perennial streams are less than
150 feet. Buffer mitigation is not required since non-perpendicular impacts to
Zone 1 are zero, and all other proposed impacts are allowed or exempt per 15A
NCAC 028.0233
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Page 10 of 13

Amount of stream mitigation requested (linear feet): n/a
Amount of buffer mitigation requested (square feet): n/a
Amount of Riparian wetland mitigation requested (acres): n/a
Amount ofNon-riparian wetland mitigation requested (acres): n/a
Amount of Coastal wetland mitigation requested (acres): n/a
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ^ No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ^ No ^
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ^ No ^
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ® No ^ If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Page 11 of 13

Zone* Impact
(s ware feet) Multiplier Required
Miti ation
1 4963 3 N/A
2 14797 1.5 N/A
Total 19760 0
* 'Lone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of7,onc 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration /Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.
Buffer mitigation is not reauired since non-perpendicular impacts to Zone 1 are zero,
and all other proposed impacts are allowed or exempt per 15A NCAC 026.0233
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stortnwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Existing percentage of impervious area for Phase 1 = 4.9%, Proposed percentage
impervious area for Phase 1 = 11.7%. Stormwater controls include level spreaders
and a extended dry detention basin that outlet the 1 yr storm over a 2-day period
and existing~onds on site protect downstream surface waters and wetlands.
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
The aroaosed sewer is an 8" aravity line that will connect to an existingt sewer
manhole located on the site and will eventually be treated by the City of Raleigh
Neuse WWTP
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Ycs ^ No
Is this an after-the-fact permit application?
Yes ^ No
Page 12 of 13

XN. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
None
C~~;~,L<~ _ ~i ~~ C4~~o~ ~• ,~«c January 8. 2004
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 13 of 13

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SHEET N0. IE.3,0 JANUARY 01,2004 ASSOCIATES [e-mail]