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:.M T IINO: IN
❑ 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
Address //a
Phone # (io) w
Authorized Agent��6ZZZ2:4�/
Type of Project
escriptioActivity:
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Notes or special
conditions:
Owner's me (Print)
Sig ture (owns t)
' T IIT P: : 30 . r: 1—�-T I
V6IAINTENANCE AND REPAIR
RECEIVED
Permit # nr^^'""' ""'NGTON, NC
Date previous
permit issued "'^' 1 5 2005
Project Location Information
Street Address s7 09 !�- 4-1- 1-3,azkc��4
Adj. Water Body 44 (em,k
AEC ❑ CS ROE ❑ HH ❑ IH
IdL g��
tP0 Signature
6 "9-a S /2-•3I• oS
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024