Dutchman Creek HOA

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❑ 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 1DL }kJArV)an CrePL (-t'
Address�Q
City Oak Zslarrd t N3C,
Phone # R- W r-/ 3 - 31
Authorized Agent i)f �++
Type of Project
Description of Activity:
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Notes or special
conditions:
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Owner's Name (Print)
Ha per pn L,Jcrr kS
Signatur '(owner or agent)
H OR
[rMAINTENA AND REPAIR
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Permit # �
Date previous
permit issut�i ✓AA/ r
Project Location
Street Address 5q h k S E"r
Adj. Water Body 441 Coe,4,4 L
AEC CB'CS ❑ OE ❑ HH ❑ IH
L O Signature
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Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 91 n_97A_Sn7A