Henry, Debbie

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❑ MODIFICATION ❑ EXEMPTION AINTENANCE AND REPAIR
Town of Oak Island Permit #
CAMA Minor Permit Office Date previous
As authorized by the State of North Carolina permit issued
per the Coastal Area Management Act of 1974
,4ddress
Phone # (Ito) �2 .-7
Authorized Agent
Type of Project
Description of Activity:
Rr s �d,r� �w•�i/m:
Notes.or special
conditions:
Name
Signature (owner or agent)
Project Location Information
Street Address 1/5;2 9
Adj. Water Body
AEC ❑ CS ❑ OE ❑ HH ❑ IH
LP Signature
Sy -off -1-0
Issuance date exp. Date
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024