Gardner, Brenda

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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
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City
Phone # (`ld 60 -a335 =/ /
Authorized Agent u
Type of Project
Descrip ion of T ctyrpQO�
Notes or special
conditions:
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Owner's Name (Print)
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S gn re (owner or agent)
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Permit # U
Date previous
permit issued APR 18 pg
CnAo D1V1SION n,-
- " 1H1- MA yr
Project Location Information T
Street Address n20 04 i 4J /Q
Adj. Water Body
AEC ❑ CS ©'OE ❑ HH ❑ IH
LPO ignature
°Joeds 12.31-o5'
Issuance date exp. Date
Oak Island Development Services - 518 Yaupon Drive - Oak Island NC 28465 - 910-278-5024