Darr, J.L.

❑ 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 T L rpAizF--
Address- 4 19 rzn
City '[`2I N I TX N . c--
Phone # (336) 4V - 915 S
Authorized Agent
Type of Project
Description of Activity:
2FIVDvA-r orj
Notes or special
conditions:
>7 A R R--
Owner's Name (Print)
nature (owner or agent)
❑ MAINTENANCE AND REPE I V ED
Permit # DCMWILMINGTON, NC
Date previous
permit issued JUN 1 5 %005
Project Location Information
Street Address 179 05 W. 13icAc N DR-
Adj. Water Body ATL A ti-rl C-
AEC ❑ CS JOE ❑ HH ❑ IH
LPO Signature
Ko • Y o S- /2 - 3/- e S
Issuance date exp. Date
Oak Island Development Services - 518 Yaupon Drive - Oak Island NC 28465 - 910-278-5024