Brooks, W.

❑ 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
PE: ;riZT IF : : : G: =XX
MAINTENANCE AND REPAI
04) Permit # 07�-03
Date previous
permit issued
Applicant Name VU I I2 v OU 'L-S
Address
City C�
Phone # ( )
Authorized Agent
Type of Project
Description of Activity:
Notes or special
conditions:
W t [A
Owner's Name (Print)
'Siure (owner or agent)
Project Location Information
Street
Adj. Water Bod
AEC ❑ CS E ❑ HH ❑ IH
Oak Island Development Services — 518 Yaupon Drive — Oak Island NC 28465 — 910-278-5024

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