Bordeaux, Richard W.

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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 %c 0%ed W . I k E4ti.4 a
Address I (o Z11 Zd.-N PA. i•
City � 4AJ. ,LJ,(-.
Phone#(914) 7,74-(oroS
Authorized Agent
Type of Project
D7caption of Activity:,
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To �S,E
Notes or special
conditions:
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Own 's Name (Print)
Sign ture (owner or agent)
❑ MAINTENANCE AND PP ¶',y zvE
Permit # I
Date previous MAR 10
permit issued ZO1)rJ
DIVISION OF
I.OAS 1AL MANAGEMEN
Project Location Information
Street Address 25-o7
Adj. Water Body_ ANC � 5
AEC 9CS ❑ OE ❑ HH ❑ IH
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Signature
2-Zsd5" d5-
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024