Elk's Lodge

❑ MODIFICATION jk'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 4 od' ,P
Address 10(e E �01�►;, . )�sr
city cC-)C.)c n C- Aglc
Phone # (qlz�) oZ7 8 - -20o7
Authorized Agent c)bn 1-,V; (sa.-,
Type of Project
Description of Activity:
Notes or special
conditions:
Owners Name (Print)
Sighatthe (omMer or agent)
.�—dIT P: .30 3r: —.?I
❑ MAINTENANGF,,,.AND RF,QAIR
vv Permit # 7777l7 ; �j
Date previous
permit issued + � 05
�S
DIVISInis n�
VI
Project Location Informa4ion7
Street Address MU
to L ���a►.;
Adj. Water Body Ae,,p i
AEC ❑ CS ❑ OE �;41-1 ❑ IH
PO ignature
3- 1 , of 6. 30O .S
Issuance date exp. Date
Oak Island Development Services - 518 Yaupon Drive - Oak Island NC 28465 - 910-278-5024