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HomeMy WebLinkAbout11-79 Ervin & Margie Nates - Shawnee District - BackfileSIT Third Cut #953R Pryartment of Planning anb Pr6dayluml P. O. Box 601 JOHN RILEY 9 COURT SQUARE PLANNING DIRECTOR WINCH15STER, VIRGINIA 22607 January 24, 1980 Mr. & Mrs. Ervin D. Nates 1066 Sensehy Road Winchester, Virginia 22601 Dear Mr. &'Mrs. Nates: This letter is to inform you that your conditional use permit for a home occupation/kindergarten has been reviewed administratively and renewed for one year effective January, 1980. This permit will be automatically reviewed each year.during the. month'of January. If you have any questions;--z lease do not hesitate to contact -this office. Sincerely, John R, Ri1ey, D'rector JRR:bjs CC: Mr, Stan Pangle, Interim County Administrator, ..fF i i j 7031662-4532 0 D l/- 7 i r CONDITIONAL USE PERMIT NO. 011-79 Ervin D. & Margie Nates zoned R-3/.5 acres _ cam'"ti Location: On North side of Route 657 just West of I -al. (Please see attached map.) Adjacent Land Use and Zoning: Farming and Residential Development, R-3. \\ \\ Review Comments: Frederick -Winchester Health Department - Will inspect at request of Virginia Welfare Department_ Virginia Department of Welfare - Will contact applicant direct with requirements. Virginia Department of Highways and Transportation - No objection. Department of Public Works Department of Inspections - If approved, a site inspection will be required to determine what code requirements apply. Applicant must submit floor plan. Zoning - Could be approved as a home occupation since it would meet definition requirements. Planning - Virginia Department of Welfare allows family day care for up.to 9 children. Over 9 children would constitute a Day Care Center. While zoned R-3 this home is not in a subdivision development and it does not appear that drop off or pickup traffic would be a problem. Plan recommends medium density residential development. Staff Recommendation: Staff recommends approval of a one-year, non -transferable permit with no one employed except resident family members, hours 8 a.m. to 6 p.m., no more than nine children, and no parking on highway right-of-way; and that a fenced play area be provided; and that the permit would become void if the Virginia Department of Welfare or the Department of Inspections cannot approve the use. 0 6 r/11- 7 119 Location: Adjacent Land Use and Zoning: Proposed Use: Review Comments: Staff Recommendation: CONDITIONAL USE PERMIT NO. 011-79 Ervin D. & Margie Nates zoned R-3/.5 acres On North side of Route 657 just West of I-81. Farming and Residential Development, R-3 Home occupation - Child care center to care for up to 10 children. Frederick -Winchester Health Department - Will inspect at request of Virginia Welfare Department. Virginia Department of Welfare - Will contact applicant direct with requirements. Virginia Department of Highways and Transportation - No objection. Department of Public Works Department of Inspections - If approved, a site inspection will be required to determine what code requirements apply. Applicant must submit floor plan. Zoning - Could be approved as a home occupation since it would meet definition requirements. Planning - Virginia Department of Welfare allows family day care for up to 9 children. Over 9 children would constitute a Day Care Center. While zoned R-3 this home is not in a subdivision development and it does not appear that drop off or pickup traffic would be a problem. Plan recommends medium density residential development. Staff recommends approval of a one-year, non -transferable permit with no one employed except resident family members, hours 8 a.m_ to 6 p.m., no more than nine children, and no parking on highway right-of-way; and that a fenced play area be provided; and that the permit would become void if the Virginia Department of Welfare or the Department of Inspections cannot approve the use_ Planning Commission Recommendations: The Planning Commission unanimously recommends approval with conditions that the permit be for one year period, none -transferable, no employees accept family members, hours 8:00 a.m. to 6:00 p.m., no more than nine children, no parking on highway right-of-way, that fenced play area be provided and'that the permit' would become void if Inspections or Welfare cannot. approve the use. The Planning Commission expressed concern. that Health Department approval had not yet been granted but since Health Department approval is necessary for Welfare Department approval they decided that it would be best to approve the' application with the above conditions rather than put the applicant in the position of .not being able -to get County approval without State approval and . vice versa. /LCN • JeK /V �µqs ')'�k . No. Zoning Application for CONDITIONAL USE PERMIT Date to COUNTY OF FREDERICK, VIR>GINIA Property Identification Number �` ���, Ctg fi1lC Magisterial District S ,.-I- (we), the undersigned, do hereby respectfully make application for a CONDITIONAL USE.;.. PERMIT, and in support of this application, the. following facts are sho-,,T.nl 1. The applicant &1fl W V-92Gc e.1 /Udk!' (are) the owner (lessee or contract holder) of property situated at /?j66 5e_,'V _C-A/icy 6�P�i/ftCCl/!E' C�yL 11114 -- fronting state route J7 consisting of acres, and descrAbed in deed book ' 1'3olg page o 2.. The type of use and/or improvements proposed are as follows: /0 � pT 0,14i ,eleeeul 3. New buildings to be constructed are as follows: pv"' 4., Additions to existing buildings are as follows: i(,c erylp— 5. The following are all of the individuals, firms, or corporations owning property adjacent to both sides and rear, and the property in front of (across street froxn.) the property. (Use additional pages if necessary.) NAME Numbers - COMPLETE ?AILING ADDRESS (Street, Route, Box, Etc. Nos.) PARCEL TAX 141XP a�� > :1A M140y t(,,Q, d—��—, —t ,l -�- �a �1�— -- e f 9 i2 1 l (NOTE: Information may be obtained from the Office of the Commissioner of Revenue_) d(` 6. .Rlease attach a sketch�'of"the ,property showing existing and proposed•rbuildings_ 7. I (we), accept and agree to comply with any conditions required by the Board ofr Super- visors of the County of Frederick, Virginia, and authorize the County to go upon the property for the purpose of making site inspections. SIGNATURE: By: ADDRESS: /%iL /_ r�(1 Dnr.iY�/r��A �r� I/1 /DM �✓f�rnOA7 I /!1 The CONDITIONAL USE PERMIT Application of �t,%V was reviewed by the PLANNING COMMISSION on (date) �� 7 2 with the following RECOMMENDATION(s) to the Governing Body: APPROVAL with the following condition(s) per the list below: -OR- DENIAL for the following reason(s) per the list below: /_% G �/O�© v v By: Secretary, Planning Commission for the County of Freder ck,Virg ------------------------------------------------------------------------- 'The CONDITIONAL USE PERMIT Application of -a was reviewed by the BOARD OF SUPERVISORS (Governing Body) on (date)�— and took the following action: APPROVED with the following condition(s) per the list below: - OR - DENIED for the following reason(s) per the list below: '�1/� i. � III � ����i �� .� i�l/ �� � � < < e .. � • EM By G ���1 � � i�/ D _r 2� A �� _VV j_ 9_-7n.� _ Zoning Code Administrator for Board of Supervisors of the County of Frederick, Virginia .. rj.,,. t7:• �� .�... 1i � �,,. .?,:`: ,;i/ i;..,5•?.E?°jt�..�i.y�`r..�, k f r,.C1 i ,, 4. y - 1tLZER ty > t 01 !:'+ '� ,�' X-\. •, ',�� •• , r `� ( �1 �`=� \ ,ram. Oil 71.�, Bkf wi • ll J -1- ` I• o f ��� tom--• 8 3 �. �— • C ` \� J�- `v �r'rr :.'�' • / may, „ y r. - A �.. MH ^� �, B-2041) ,ram cl cm O ,\\ »� . �•\(\ �Wl� (135) E ` t h M , c ri r t n e ,I 7 x 28 / 1336 t u .�' - fig✓ :ii/o� 49350WmN. -, © �` sue-{ -I/ © 1�jrt1 �' ) � r�� �r � •,` ��`. Q 01, 7450w--E yFR IV7-N,) AC iS "I. INTE RJOR-GEOIOG11- 1­ll 7 j 78' 07':rO N } ROAD CLASSIFICATION c% o- Heavy-duty__ _ Light-duy_..._•_ . F Medium -duty:._ Unimproved dirt =_-_____, ' ' C) Interstate Route C3 U. S. Route O State Route i VIRGIN { WINCHESTER, VA. rr _ QVADRANGLE'IOCAT1ON N3907.5—W7807.5/7.51966 "+a PHOTORFVIS£0 2973 t, H. PONALO BERG PLANNING DIRc:CTOR DOROTHEA L. STEF£N .XONING ADMINISTRATOR T0: xC--Trf_r . i lffln- cniag all lei .bt0p,lit- it m e.m o r a n d u m Frederick -Winchester Health Department ATTN $ob Kauchak Va. Department "of Highways & Tranportation , ATTI, R. C: King Department of Inspections , ATUT Carroll Brown ATTL . Dorothea L. Stefen, Zoning Administrator Data May 23, 1979 FRQI`lI SUBJECT. Review comments on xx Conditional.Use Permit. Su�cliviszor� Rezoning Sloe. Plan We are reviewing the enclosed request by Ervin D. &Margie .I. Nates or their representative 662-6150 ^_ Will yi7Lt p1 ase review the attached and return your comments to me by June 20, 1979 This space -should be used for, review comments, t✓YJ %(l i j l l _ j� G� 0/ Yef'Al 0 C_>° — v C _�,P e DateSignature RECEIVED'mtv') o 79' Xr;�brrirh Q;rfunt� RE(covLO ., j tyartia fAY 2 t i ­7 1-1.' RONALD BERG 'PLANNING DIn=rOR DOROTHEA L. STEFEN ZONING kDMINISTRATOR in e m o r a n d U M St COUR-17 SQUARE. VPRG;�fA 2ascr. TO: Frederick -Winchester Health Department ATTN Bob Kauchak Va. Department of Highways & Tranportation ATTN, R_ C. King Department of Inspections ATUT -Carroll Brown ATTN FROM: SUBJECT: Dorothea L. Stefen, Zoning Administrator Date MaY 23, 1979 Review comments on' xx Conditional .Use Permit Su-bd±vlaion, Rezoning Sites Plan. We are reviewine, the enclosed request by Ervin D. & Marg'�e:_I. -Nates or their representative 662-6150 review the attached and return your -comments to me by --------------------- 7 -------- ------ ------------------ This space -should be used for . review ,-.comments : No objection O si(n-).ature Date May 24, 1979 0 31, -36 2­1532 H. RONAL.D BERG PLANNING DIRECTOR DOROTHEA L. STEF'EN ZONING ADMINISTRATOR 3fze.berich (gountu Repartza.ertt oaf 111anning anb Qfx n P. 0. Box 601. 9 COURT SOLIDARE WINCHESTER', VIRG11MIA 22601, June 25, 1979 Ervin and Margie Nates 1066 Senseny Road P. 0. Box 3032 Winchester, Virginia 22601 Dear Mr. & Mrs. Nates: During a site inspection.of .the property on Senseny, Road.for which you are seeking a conditional,use permit, it was apparent that you ha& not. yet placed a sign regarding the upcoming, public hearing,_,. This sign must.be placed immediately or the Planning Commission will.be unable. ta hear your case. .The sign should be at least 36".X 48".. You should state that a::: Conditional Use Permit Hearing for Home Occupation.- Childare.will be held on July 5, 1979 at. 3:.00 p.m. in the Board of ' Superviso s`:Room, 9.Court Square, Winchester, Virginia. Sincerely, Dorothea L. Stefen, Acting Director Planning and Development DLS:bjs cc: J. 0. Renalds, County Administrator C. Langdon Gordon, -Planning Commission 703/662-4532 SENDER Complete items I. '. and i. Add your address in the "RETURN TO'' space on reverse. 1. The f9llowing service is requested (check one). tF;KSShow to whom and date delivered .......... ❑ Show to whom, date, and address of delivery..,¢ ❑ RESTRICTED DELIVERY Show to whom and date delivered..........¢ ❑ RESTRICTED DELIVERY. Show to whom, date, and address of delivery. $ (CONSULT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO:�� r J s v� � • �c��-c S , ; 3. ARTICLE DESCRIPTION: REGISTERED NO. CERTIFIED NO. INSURED NO. I �5�� o 4 (Always obtain signature of addressee or agent) I have received the article described above. SIGNATURE ❑ Addressee .Authorized agent � �❑ Vt 4. "'� `^ DATE OF DELIVERY S JUN z 2 1979 5. ADDRESS (Complete if !d �(10 C.. 4r� only req 6. UNABLE TO DELIVER BECAUSE: INLERK'S INITIALS *GPO : 1978-272-932 UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS Print your name, address, and ZIP Code in the space below. • Complete items 1, 2, and 3 on the reverse. • Moisten gummed ends and attach to front of article if space permits. Otherwise affix to back of article. • Endorse article "Return Receipt Requested" adja- cent to number. PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE, $300 t=MMAIL RETURN TO 0Dept. of Planning & Development COUNTY OF FREDERICK, VIRGINIA P. 0. Box 601 Winchester- Virginia 22601 (Name of Sender) (Street or P.O. Box) (City, State, and ZIP Code) No. 858785 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED — NOT FOR INTERNATIONAL MAIL (See Reverse) SENT TO ` : \ S EET AND NO. O P O,, STATE AND ZIP CODE n Y V POSTAGE $ y W CERTIFIED FEE Q W LL — SPECIAL DELIVERY Q 2 O RESTRICTED DELIVERY Q W W F U U SHOW TO WHOM AND Q co > > W DATE DELIVERED Q W SHOW TO WHOM, DATE, N y d AND ADDRESS OF Q 0 Z W DELIVERY d O W SHOW TO WHOM AND DATE a Cr DELIVERED WITH RESTRICTED Q N p Z DELIVERY CCSHOW TO WHOM, DATE AND O ADDRESS OF DELIVERY WITH Q U CC RESTRICTED DELIVERY TOTAL POSTAGE AND FEES $ POSTMARK OR DATE STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CER71HED MAIL FEE, AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES. (see front) 1. If you want this receipt postmarked, stick the gummed stub on the left portion of the address side of the article, leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier. (no extra charge) 2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address side of the article, date, detach and retain the receipt, and mail the article. 3. If you want a return receipt, write the certified -mail number and your name and address on a return receipt card, Form 3811, and attach it to the front of the article by means of the gummed ends if space permits. Otherwise, afix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested, check the applicable blocks in Item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. No. 956762 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED — NOT FOR INTERNATIONAL MAIL (See Reverse) SENT TO 1, - K1 STREET AND NrO�. /0b PO STATE AND ZIP CODE \ \ ' \n V POSTAGE $ y W CERTIFIED FEE Q W U.SPECIAL DELIVERY a Q RESTRICTED DELIVERY Q W W W F U U > SHOW TO WHOM AND > W DATE DELIVERED W SHOW TO WHOM. DATE, J r (a ` a AND ADDRESS OFLAND O 2 WDELIVERY 6 O WSHOW TO WHOM AND DJ a ¢ DELIVERED WITH RESTRa O 2 DELIVERY =O H SHOW TO WHOM, DATE ADDRESS OF DELIVERY G RESTRICTED DELIVERY TOTAL POSTAGE AND FEES POSTMARK OR DATE STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE, AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES. (see front) 1. If�you want this receipt postmarked, stick the gummed stub on the left portion of the address side of the article, leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier. (no extra charge) 2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address side of the article, date, detach and retain the receipt, and mail the article. 3. If you want a return receipt, write the certified -mail number and your name and address on a return receipt card, Form 3811, and attach it to the front of the article by means of the gummed ends if space permits. Otherwise, afix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested, check the applicable blocks in Item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. SENDER: Complete item; 1. 2, and ;. Add your address in the "RETURN TO'' space on reverse. 1. The lowing service is requested (check one). Show to whom and date delivered.......... ¢ ❑ Show to whom, date, and address of delivery..¢ RESTRICTED DELIVERY Show to whom and date delivered.......... ¢ RESTRICTED DELIVERY. Show to whom, date, and address of delivery. $ (CONSULT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO: C a 7� r7 0 6 Y�- 3. ARTICLE DESCRIPTION: REGISTERED NO. CERTIFIED NO INSURED NO. I (Always obtain signature of addressee or agent) I h e rec 'ved the article described above. SI NATUR ❑ Addressee ❑ Authorized agent A7 �� ATE OF DEL ERY l ( $TMARK 5. ADDRESS (Complete only if requtat d) 6. UNABLE TO DELIVER BECAUSE: `"^•-•'INITIALS i CLERK'S L *GPO : 1978-272-932 UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS Print your name, address, and ZIP Code in the space below. Complete items 1, 2, and 3 on the reverse. • Moisten gummed ends and attach to front of article if space permits. Otherwise affix to back of article. • Endorse article "Return Receipt Requested" adja- cent to number. RETURN Tn PENALTY FOR PRIVATE USE TO AVOID PAYMENT OF POSTAGE, $300 u (-Name of Sender) <3 -x (Street or P.O. Box) (City, State, and ZI Code) TO THE APPLICANT(s) and/or ADJOINING PROPERTY OWNERS(pl :, The Application Of: Ervin D. and Margie T. Nates Conditional Use Permit for: To keep children (10), 2 years to kirfdergarten age in the home. 1 The Conditional. Use Permit request will be considered during the: Frederick, County Planning Commission's"meeting at: 2:00 p.m., July 5, 19791 in the Board of Supervisors Meeting Room, 9 Court Square, Winchester, Virginia_ Any interested parties having questions or wishing to speak, may attend' this meeting. Sincerely', t7� Dorothea L. Stefen Zoning Administrator cc - J. 0. Renalds, County Administrator DLS:bsw 4 No. 95�791 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED — NOT FOR INTERNATIONAL MAIL (See Reverse) SENTTO ,,..11 STREET AND NO. 3 � P.O., STATE AND ZIP CODE vS, aa�o POSTAGE $ y W CERTIFIED FEE Q W LL SPECIAL DELIVERY - Q S O RESTRICTED DELIVERYIr Q LL W W U U SHOW TO WHOM AND Q I-- > > W DATE DELIVERED Q W SHOW TO WHOM, DATE. — :E to y Q a AND ADDRESS OF Q O 2 W DELIVERY a O W SHOW TO WHOM AND DATE a CC DELIVERED WITH RESTRICTED Q M O Z DELIVERY ycc O SHOW TO WHOM, DATE AND U W ADDRESS OF DELIVERY WITH Q Cc RESTRICTED DELIVERY TOTAL POSTAGE AND FEES $ POSTMARK OR DATE STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE, AND CHARGES FOR ANY SELECTED OPTIONAL SERVK:ES. (see front) i . If you want this receipt postmarked, stick the gummed stub on the left portion of the address side of the article, leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier. (no extra charge) 2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address side of the article, date, detach and retain the receipt, and mail the article. 3. If you want a return receipt, write the certified -mail number and your name and address on a return receipt card, Form 3811, and attach it to the front of the article by means of the gummed ends if space permits. Otherwise, afix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested, check the applicable blocks in Item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. SENDER: Complete item; I. '..--d ;. Add your address in the "RETURN TO'' space on reverse. t. The (lowing service is requested (check one). Show to whom and date delivered .......... —_c Show to whom, date, and address of delivery..¢ RESTRICTED DELIVERY Show to whom and date delivered.......... ❑ RESTRICTED DELIVERY. Show to whom, date, and address of delivery.$— _ (CONSULT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO: 3. ARTICLE DESCRIPTION: REGISTERED NO. CERTIFIED NO. INSURED NO. 14�-37L-1 (Always obtain signature of addressee or agent) I have received the article described a ve. SIGNATURE ❑ Addres - ❑ thorizcd agent 4. D E OF DELIVERY r TNIARK. I rar 5. ADDRESS (Complete only if requ 1979 i rt ' 6. UNABLE TO DELIVER BECAUSE: I NI IALS *GPO : 1978---272-932 UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS PENALTY FOR PRIVATE USE TO AVOID PAYMENT Print your name, address, and ZIP Code in the space below. OF POSTAGE, $300 • Complete items 1, 2, and 3 on the reverse. • Moisten gummed ends and attach to front of article U.S•MAIL if space permits. Otherwise affix to back of article. • Endorse article "Return Receipt Requested" adja- cent to number. RETURN TO (Name of Sender) r3ay 61 _ (Street or P.O. Box) (City, State, and Z.IP Code) SENDER: Complete items 1. ', and ;. Add your address in the "RETURN TO" space on reverse. 1. The ollowing service is requested (check one). Show to whom and date delivered.......... ¢ ❑ Show to whom, date, and address of delivery.. ¢ ❑ RESTRICTED DELIVERY Show to whom and date delivered .......... ¢ ❑ RESTRICTED DELIVERY. Show to whom, date, and address of delivery. $ (CONSULT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO: V'C�e�c- V ozq o v V file. �,c,6�e 3. ARTICLE DESCRIPTION: REGISTERED NO. CERTIFIED NO. INSURED NO. I (� S 3 7 6 al (Always obtain signature of addressee or agent) I have received the article described above. SIGNATURE ❑ Addressee ❑ Authorized agent 4. DATE OF DELIVERY MARK 5. ADDRESS (Complete only if request 6. UNABLE TO DELIVER BECAUSE: ERWS" INITIALS *GPO : 1978-272-932 UNITED STATES POSTAL SERE; T OFFICIAL BUSINESS �• }`� SENDER INSTRUCTIONJ011 \111 Print your name, address, and ZIP Code in th space beA. • Complete items 1, 2, and 3 on the reJerse. ttach Iq?4 • Moisten gummed ends and ato frd�t of a icle if space permits. Otherwise affix to back QfarDi�1 0 • Endorse article "Return Receipt Requested-`ad)a cent to number. RETURN TO PENALTY FOR PRIVATE USE TO AVOID'PAYM61tt„�,ar= OF POSNM�-6iQQ ���er�`�� Lc. (Name of Sender) (Street or P.O. Box) tic-,. a2 2- O (Ctt3•, State, and ZIP Code) No. 953760 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED — NOT FOR INTERNATIONAL MAIL (See Reverse) SENT TO \c- STREET AND NO. P.O., STATE AND ZIP CODE POSTAGE $ y W CERTIFIED FEE a IL ILL SPECIAL DELIVERY Q O RESTRICTED DELIVERY Q W W w ~ U U SHOW TO WHOM AND Q N > R > DATE DELIVERED ywW SHOW TO WHOM, DATE. y N N ` d AND ADDRESS OF a O 2 1Y DELIVERY a O W SHOW TO WHOM AND DATE ~j a G DELIVERED WITH RESTRICTED Q N O 2 DELIVERY -1 SHOW TO WHOM, DATE AND C U OF DELIVERY WITH Q QADDRESS RESTRICTED DELIVERY TOTAL POSTAGE AND FEES $ POSTMARK OR DATE STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE, AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES. (see front) 1. It you want this receipt postmarked, stick the gummed stub on the left portion of the address side of the article, leaving the receipt attached, and present the article at a post office service window or hated it to your rural carrier. (no extra charge) 2. If you do not want this receipt postmarked, stick the gummed stub on the left portion of the address side of the article, date, detach and retain the receipt, and mail the article. 3. If you want a return receipt, write the certified -mail number and your name and address on a return receipt card, Form 3811, and attach it to the front of the article by means of the gummed ends if space permits. Otherwise, afix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested, check the applicable blocks in Item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. -716