Vaulk, Terry

�g?Ig ?IZN :)oR PE:
❑ MODIFICATION ❑ EXEMPTION
Town of Oak Island
CAMA Minor Permit Office
As authorized by the State of North Carolina
per the Coastal Area Management Act of 1974
Applicant Name K)q Of 4X,IARf
Address . / ,�— 1 I-? Eau f o el -
City = .Sa y'L-/—
Phone # (4i0) kgr S/ 7
Authorized Agent
ProjectType of
Description of Activity:
6 1.
SR• • .
Notes or special
conditions:
eie w r,
Ownne s Name (Print)
Signa a (owner or agent)
.?IZT PR :1110 .; R=.?Z
G�MAINTENANCE
Permit #
Date previous
permit issued 1 vnD
DIVISION OF
COASTAL MANAGEMENT
Project Location Information
Street Address yD2) C, t3ef{c�
i4K /S 114-NvZ w c.
Adj. Water Body 1477Mnl �) U
AEC ❑ CS ❑ OE ❑ HH ❑ IH
LPO Signature
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024