67902D - McKeithan

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12/15/2016 12/21/2016 1 McKeithan Family McKeithan Family BB&T 528 $200.00 GP 67902D
LTD Partnership

'ayment Proccessing Confirmation
)ate Received F 12/15/2016
heck From (Name) McKeithan Family LTD Partnership
Jame of Permit Holder McKeithan Family
/endor BB&T
;heck Number 528
;heck amount $200.00
Aultiple Permits No
Aajor/Minor
'ermit Number/Comments GP 67902D
teceipt or Refund/Reallocated TM/3460D

NC Division Of C08stai Mgt. Habitat Impact Computer Sheet
Applicant:
Date:
Permit #:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts
FINAL feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
V\J-
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge [] Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both (] Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

RCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date
Name of
Property Owner Applying for Permit:
1 `
Mailing Address:
I certify that I have authorized (agent) SEGI to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) Pier, gazebo, dock an
at (my property located at) d Ib4 �A UL
This certification is valid thru (date)

a
oi
I J
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
[ hear by certify that I own properties or I am authorized to represent the owner of properties locat
adjacent to The McKeithen Family Trust (herein referred to as the "Applicant") property, which
s
located at Lot 14 , on West Pelican Drive , in Oak Island Brunswick County , Norlh
Carolina.
The Applicant has described to me, as shown below, the proposed development at the above location,
and I have no objections to the proposal.
INSERT DESCRIPTION AND/OR DRAWING OF THE PROPOSED DEVELOPMENT:
(To be completed by the Applicantproposing the development)
********* Please see attached site plan ***********
Southern Environmental Group, Inc. —
Dana A. Lutheran Mr. Justin Huntley. Lots 13 and 15
Applicant ent Riparian Property Owner
5315 South College Road, Suite E s�` (!'►�+ (� S 3//
Mailing Address Mailing Address
NC 28412 A1 &' L 2-7G
Wilmington,g
City/State/Zip City/State/zip,
910.452.2711 c
_
Telephone Number Telepho ber
�N
Signature gn'tZ ���

Pier Head Lin
HUNTLEY JUSTIN AND
CUMMINGS MATTHEW SHEA
LOT 15
Lot 14 West Pelican Dock Plan
McKeithen Family Lmt. Prtn.
Centerline of Montgomery Slough
-55'
10
PROPOSED
BOAT LIFT
-30'
�, B
PROPOSED
8'X12'
FLOATING
PLATFORM
PROPOSED
110'X1W%
12'
PROPOSED;
`330' X 6'
FIXED DOCK
HUNTLEY JUSTIN AND
CUMMINGS MATTHEW SHEA
LOT 13
W � COR6Va�l )L I"
Property Line_J L_Property Line
Shoreline = 50'
50'x8'=400SF
Proposed SF = 212