Hupp, Russell

C. — JW _ . MMINO: P:
❑ 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
Address i +11,E
City t
Phone # ('I l f) ; � 13
Authorized Agent _
Type of Project
Description.of Activity:
,r
Notes or special
conditions:
i
Owner's Name (Print)
Signature (owner or agent)
3VKXW P: .OG: JM
0MAINTENANCEANB4ZFRIR
Permit # (JJ�dI 1 j�
Date previous 1L �l:G
permit issued
Z00j
COAeT. ," OIUN
Project Location Inforrnaioii�AGEMENT
Street Address i, ° e •:'t
L- I. , >
Adj. Water Body C
AEC ❑ CS ❑ OE ❑ HH ❑ IH
LPO Signature
4 Zai 05 ►21 -� t I acs
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024

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