Drocella, Paul

❑ 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 Name41/// 111Zr>
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Address
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Phone #
Authorized Agent
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ion of Activity:
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Owner's Name (Print)
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Signaturej(owner or age t)
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0 MAINTENANCE AND REPAIR
Permit #
Date previous
permit issued
Project Location Information
Street Address
Adj. Water Body
AEC ❑ CS ❑ OE ❑ HH ❑ IH
LPO Signature
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Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024