Ward, Brad

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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
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MAINTENANCE AND R
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Applicant Name8waP--� WAqo
CIO -SLACICOPr� con1S7
Address � q o 2 w- 01.1% N
City r9g le < I^ n r /,Jc- 2 644 S"
Phone # Ora) 278 — 3 2 2-q
Authorized Agent ''�� U^J ST'
Type of Project
Description of Activity:
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Notes or special
conditions:
80,60 WA A
Owner's Name (Print) � i ppc,
Cs��I L
Signature (ownerjor agent)
Permit #_
Date previous
permit issued_
Project Location Information
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Street Address 39oiy . A c N
Adj. Water Body
AEC ❑ CS Ci'OE ❑ HH ❑ IH
_.ear �t MC
CPC Signature
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Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive - Oak Island NC 28465 — 910-278-5024