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MODIFICATION t5 EMPTION C MAINTENANCE AND REPAIR
Town of Oafs Island
CAMA Minor Permit Office
As authorized by the State of North Carolina
per the Coastal Area Management Act of 1974
Applicant. Name cam.
Address
City
Phone # ( ) q
'I •
Authorized Agent_
Type of Project
Description of Activity:
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)
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Notes or special
conditions: j
35 ror. FS.
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Owner's Name (Print)
Signature '(owner or agent)
Permit #
Date previous
permit issued
Project Location Information
Street Address
Adj. Water Body
AEC ❑ CS ❑ OE ❑ HH ❑ IH
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024