Pickrel, Michelle

❑ MODIFICATION F7EXEMPTION
Town of Oak Island
CAMA Minor Permit Office
As authorized by the State of North Carolina
per the Coastal Area Management Act of 1974
PE: riZT : L
❑ MAINTENA AND REPAIR !�
Permit # hIAR 2 8 2005
Date previous DIVISION
permit issu OF
EMENT
Applicant Name,ti'1 %,c Or- r- ,c fi c= (.
Address ' 3) ', Cv�7oNri, �3 CT-.
city A ni c- %-B s - 13
Phone # 12
g In c Cc �r1
Authorized Agent 1,,
Type of Project
D,tYscription of tivity:
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L. ,-, r 1. AN o
(YlL
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Notes or special
conditions:
tq,, , c (A C- I I C- A C C, C
cto 6lnc%-
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Owner's Name ((Print)
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Signature (owner or dgent)
Project Location Information
Street Address 3 c oLl w . -e Ar H
0Ak /SLniy a rlc..
Adj. Water Body r - Gi' .
AEC ❑ CS ❑ OE ❑ HH ❑ IH
LPO Signature
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024