Soucy, Paul (2)

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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 Name / qv / Soe-,c /
Address 3 cr, / e�,� c sf/' C 1% fy,y/
City a/Y T I ( A
Phone # (91c) � 7 � - y Y S 7
Authorized Agent
Type of Project
Description of Activity.
Notes or special
conditions:
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Owner's Name (Print)
/ i
Signature (owner 6r agent)
2/MAIN rENANCE AID J� J� Vp 4j
Permit # �0 11 �Y JL�
Date previous MAY 0 2 2005
permit issued
OF
COASTAL IMAONAGGEMENT
Project Location Information
Street Address // f, F4J Ef4-4 0e
Adj. Water Body (9
AEC ❑ CS U,E ❑ HH ❑ IH
4d 2 �
LPO Signature
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Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024