Beach Villa

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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
Address ON w 80.
city C I,
scuTr NTwec.t-
Phone # (� )"l Q 3) -- x11q- k&Y-a734?
Authorized Agent�aa to Yrlea&
Type of Project
Description of Activity:
Notes or special
conditions:
Owner's Name (Print)
tla Il;a� t,'J i 1 '[�� �
Signature (owner or agent)
W6 AINTENANCE AND REPAIR
Permit #
Date previous
permit issued
Project Location Information
Street Address n? -)ml LJ) B 0
9 LLP�
Adj. Water Body
AEC ❑ CS ❑ OE ❑ HH ❑ IH
LPO Signature
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024