Simpson, Tony

❑ 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
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Applicant d�ame
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Address [_ti 1 .114,�rJ
4 CnSv�ltG � 30 77
City
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Phone#('•;,)
Authorized Agent kc„n44 Cvrv.hcf
Type of Project
Q scription of Activity:
7
Notes or special
conditions:
C
Owner's Nam6 (Print)
Sidnaturb (owner or agent)
e-MAINTENAN E2 HV E
Permit #
Date previous
permit issued 22 C1JQMAR 1 0 2005
DIVISION OF
COASTAL MANAGEMENT
Project Location Information
Street Address
Adj. Water Body
AEC ❑ CS ❑ OE ❑ HH ❑ IH
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LPO Signature
S J, -)S / 2 ?1- u -�-
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024