37827D - Mouser

],CAIA/ ❑DREDGE & FILL -
3ENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina,Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7 H . H 1 0
❑Rules attached.
it Name rv1 C“S C e"- I P C.- S/Project Location: County 0 Pi 0
S I pp C'a I e R 5k Street Address/State Road/Lot#(s)
-i ei 11 O h State N C_ ZIP 2-?5 2 0 7 O u( 711, D-
I.611) SS 3 "5S8 I Fax#( ) Subdivision
:edAgent S-cvc Aqi.„0. ; City Sv r( C.-1y ZIPZg 1 V
XE❑CW W XPTA X1ES ❑PTS Phone# ( ) ( River Basin (p/Oc
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❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body CM hot I (flat /
❑ PWS: ❑FC:
yes 6) PNA yes /Y Crit.Hab. yes / no Closest Maj.Wtr. Body A 2-
f Project/Activity Alet A✓IkLtr. wt ff -Io ee®?fie c x i 54‘^y •
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imber
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Riprap length 160Dti 1
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g distance offshore Z ItF►-'_ �... _.__
ax distance offshore f 1
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le Length -� ..... t i L..not sure yes no ; �- . y�rQQ.
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ling permit may be required by: . V✓` > ' 1 It . I I See note on back regarding River Basin 1

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: T 144 OUR P
Address of Property: 7 D`/V 7 5/-
(Lot or Street#, Street or Road)
" c'W F C,. /1/ C / 7 coilyi ..___
(City and County)
I hereby certify that I own property adjacent to the above-referenced-property. The individ
applying for this permit has described to me as shown on the attached drawing the development t]
are proposing. A.description or drawing, with dimensions, should be provided with this letter
i,Y'Jf I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coax
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-3!
within 10 days of receipt of this notice. No response is considered the same as no objectio
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must
set bck a minimum distance of 15' from my area of riparian access-unless waived by me.
you wish to waive the setback, you must initial the appropriate blank below.)
ifrI do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
. ,-/L i." -'
Sign Name Date
Q.,Lr. i P. ,_e . A'!E' A

i
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Si ture
item 4 if Restricted Delivery is desired. X CI Agent
• Print your name and address on the reverse ❑Addressee
so that we can return the card to you. ga,. Received by(Printed Name) C. Date of Delivery
• Attach this card to the back of the mailpiece,
or on the front if space permits. (A (.1 S t - -; 1 -
1. Article Addressed to:
D. Is delivery address different from item 1? CI Yes
/(// If YES,enter delivery address below: C] No
' \I L{' .e4 riJ P(}05-e-
/4 3 5,7-4 4.„,..f y 0,4 .di-i.
3. Se e Type
a/VC_N S V;//// MC, Certified Mail CIExpress Mail
' El Registered ❑ Return Receipt for Merchandise
7 0p 37`? ❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) Cl Yes
2. Article Number
(Transfer from service label) 7002 2410 0006 5594 4630
PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
• Complete items 1,2,and 3.Also complete A. Signature, (� ��J
item 4 if Restricted Delivery is desired. X t-
`s--. �`��,,,\ ❑Agent
• Print your name and address on the reverse "�1J ❑Addressee
so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery
• Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different from item 1? El Yes
1. Article Addressed to:
If YES,enter delivery address below: 0 No
hu 1-t000ct b ' .1
Y
t-1 ,n� nl� p. Lr �, 3 Se ceType
�� �T��_�l III' I"�� r9 + `�— r�jfled Mail ❑ Express Mail
�/ .., gistered ❑ Return Receipt for Merchandise
Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number
(Transfer from service label) 7002 2 410 0006 5594 4623
PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540

BANK OF AMERICA
ANTINORI CONSTRUCTION
896 HWY.210 66 19/530
HOLLY RIDGE, NC 28445
[phone]
PAY $
TO THE �
ORDER OF
71Xii,e..it Ads, -1-71/Av‘- _.....-
• 3 O AUTHORIZED SIGN URE
MEMO ^�7�ja�
116004 L 28" ,:0 5 3000 196i: 0006 50 5 2 199011'