Polhemus, Gene

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PE: TIZT P: : : GR'TIE
❑ 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
L
Phone # iJ
Authorized Agen r! GkA,S�NS�
Type of Project
Notes or special
conditions:
GEC- Poi C-07tA-5
Owner's Name (Print)
Sig ure (o ner or agent)
Y'MAINTENANCE AN P�� � � R
Permit # \\�y/
Date previous
permit issued 2005
ED
DIVISION OF
Project Location Information
Street,p�ddress W
leilam,NA�
I
Adj. Water Body
AEC ❑ CS E(OE ❑ HH ❑ IH
LFT Signature
y-,zG-os 12.31•05
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024