Ehacher, David

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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
Address ` 0L/ &14C( AV 1
City 94A'inoRc r IKArcY14"d AIZ2.1
Phone#(4(n) a31-1965-
Authorized Agent
Type of Project
Description of Activity:
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Notes or special
conditions:
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Owner's Name (Print)
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nature kowner or agent)
❑ MAINTENANCE AND REPAIR ;
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Permit #
Date previous
permit issued
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Project Location Information
Street Address 2 7 West
04-k-5/r9-v5AI.C.
Adj. Water Body
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LP6 Signature
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Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024