Everhart, Ralph

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MODIFICATION
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❑ 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 29YS'w: tI a.A PQJ
City W -5 ne , (f
Phone # 334 - 7,6 t& - So C 3
Authorized Agent
Type of Project
Description of Activity:
Notes or special
conditions::
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Owner's Name (Print)
Sig ature (owner or agent)
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9'hAAINT Nr-E AN.D REPAIR
Permit #
Date pre s
permit i FFR 9 O nnM
DIVl.qtnni n,
Project Location InformalilrT
Street Address 3 6 16 W e-s7 -�t�4
Adj. Water Body 4 Vim, L
AEC ❑ CS E UE ❑ HH ❑ IH
L Signature
,4•1y of 11v,3O,0S
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024