Nathan, Julie

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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-'j"Ut-le A/ ^�4MAV
Address moo /rose?AL D.f . sa�7Z"q
City G&j''oe ivG Zrr72 j
Phone # (BLS �/5'z Elsa
Authorized Agent
Type of Project
Description of Activity:
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Notes or special
conditions:
IV A14-rAIA,01
Owner's Name (Print)
Signature (ow�erbr agent)
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❑ MAINTENANCE AND REPAI� Ji C
Permit #
Date previous MAN Z 3 2G05
permit issued
1\1 OF
COASTAL MANAGEMENT
ProjectProject Location Information
Street Address �Li-o7 /.d. d!f K 4
Adj. Water Body OG6r4AI
AEC ❑ CS 21! E ❑ HH ❑ IH
LPO ignature
3-//. a1- /2•.3/•VS
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024