Star, Peter

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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
Address?bY K�CINE IDa. 0/03
city � To - f 1( 200 3
CI- QID
Phone # (q/0) �ql -qTt l 202-30e
Authorized Agent
Type of Project
D scription of Activity: `
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Notes or special
conditions:
P4 K Sf
Owner's Name (Print)
Ignature (owner or agent)
P'IiAA1NTENANCE AND REPAIR
Permit #
Date previous
permit issued
Project Location Information
Street Address ZS/ I W . Pe II CAN Q7
(kr� MAD 2-kYCn S
Adj. Water Body. 3 0-0 POW
AEC ❑ CS ROE ❑ HH ❑ IH
PO Signature
531-05 /2-3y. 0 5-
Issuance date exp. Date
Oak Island Development Services - 518 Yaupon Drive - Oak Island NC 28465 - 910-278-5024