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GENERAL PERMIT Previous permit#
'New -Modification ❑Complete Reissue Partial Reissue Date previous permit issued
>rized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC 7 H. 1 Z 0 0
❑Rules attached.
It Name Y-1'`e v e P 1 I 1 S . Project Location: County 0 n 3 I o W
3 28 A,' . 1-;.-1 I o r' 2e1 Street Address/State Road/Lot#(s)
? ; cintr. t-‘015 StateNC- ZIP 285 1.1 30 / 2- 3 d S-1
(110)3 2,44-51-1 Z7 Fax#( ) Subdivision p
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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit: 5 €4/e Jv4
Address Of Property: ' b 7 _ 7 5�'
(Lot or Street #, treet or Road, City & County)
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,
should be provided with this letter.
I have no objections to this proposal .
If you have objections to what is being proposed, please write the
Division of Coastal Manaaement, 127 Cardinal Drive Extension,
Wilmincxton, North Carolina, 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response is considered the same
as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift or sandbags must be set back a minimum distance of 15'
from my area of riparian access unless waived by me. (If you wish
to waive the setback, you must initial the appropriate blank
below. ) `
4
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name Of Individual Applying For Permit: $�E"VC
Address Of Property: 30 7-2 3 r° 5 t
qvr �-= e z 9 /yc
(Lot or Street #,/Street or Road, City & County)
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,
should be provided with this letter.
r I have no objections to this proposal .
If you have objections to what is being proposed, please write the
Division of Coastal Management, 127 Cardinal. Drive Extension,
Wilmington, North Carolina, 28405 or call 910 395-3900 within 10
days of receipt of this notice. No response is considered the same
as no objection if you have been notified by Certified Mail
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat
house, lift or sandbags must be set back a minimum distance of 15'
from my area of riparian access unless waived by me. (If you wish
to waive the setback, you must initial the appropriate blank
below. ) •
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.

ANTINORI CONSTRUCTION BANK OF AMERICA
896 HWY.210 66-19/530 Z
HOLLY RIDGE,NC 28445
[phone]
TO HEAi/C $
ORDER OF
AUTHORIZED SIGN URE
MEMO 3 7$a-�
II.004 28116 1:053000 L961: 0006 50 5 2 L99011'