Davir, Ronan

;.' rIL?ZZ_IO: PE: ?IIT P: O �RATX
Q"MODIFICATION I ErT/�Jj�V H F AINTENANCE AND REPAIR
Town of Oak Island �� ��++ f� P it #
CAMA Minor Permit Office R $ 2 D e previous —�—
As authorized by the State of No roli� it issued �2I I g I (\ S
per the Coastal Area Manageme A of697ISION OF
COASTAL MANAGEMENT
Applicant
Address
City �1 I ��i C�S�.T J \ 7{r
Phone # (&4') 45 SL y 6 S k--
Authorized Agent
Type of Project
Description of Activity:
Notes or special
conditions:
Owner's Name (Print)
Signature (owner or agent)
Project Location Information
Street Address a 2 7 2 T--, ; rA c ,,
Adj. Water Body
AEC ❑ CS 19'bE ❑ HH ❑ IH
LPO Signature
Iss lance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024