05-205

❑ 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 i% 5.. 7--r Y7r-?
City C C?/<' _%4cfar„ %VC.
Phone #
Authorized Agent
Type of Project
Description of Activity:
Notes or special
conditions:
Owner's Name (Print)
Signature (owneroeagent)
30 -W: 4-.6.r11
❑ MAINTENANCE AND REPAIR
Permit# R9
Date previous \\!
permit issued v
ci MAY 0 6 2005
Project Location fo d ivry ur
C , ANAGEMEN
Street Address !`' ✓,8
Adj. Water Body
AEC ❑ CS P10E ❑ HH ❑ IH
j<_ 1
LPO Signature
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024