Fortier, Julia 80081C

.aCAMA /.tr DREDGE & FILL \
.ENew EModification EComplete Reissue EPartial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pu rsuant to l5A NCAC
N980081 A B c D
Previous permit # _
Date previous permit issued_
E Rules attached
Applicant Name _
Address
State ztP
Phone#( ) E-Mait
Project Location: County
Authorized Agent _
Subdivision
City _ ztP
Phone # ( )_ River Basin
Adl. Wtr
Closest Mal. Wtr. Body
Affected J CIV tJ EIV - PTA
AEC(s): oEA - HHF - lH
L ] PWS:
ORW: yes / no *
^.
, no
trES
.- UBA
tr PTS
DN/A (nat /man /unkn)
)C
Type of ProjecU Activity
Pier (dock) lengh
Fixed Platform(s) _
Floating Platform(s) _
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length.
avg distance offshore
max distance offshore
Basin, channel
*+:tj
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l--t:
+-,!iir*-i-li
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lli:!r-'-i-: _-'i
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j
cubic yards_
i+ l-tll+-f_l j*,_-_i_,-fi{-+-H-+1,,'+-+_-L
r+1
F.-**l
+-
L
Boat ramp
Boathouse/ Boatlift
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1
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tti.IJI
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Beach Bulldozing
Other
;*rl-T;fi-r-i TTr-*T1-
Shoreline Length
SAV: not sure
Moratorium: nla
Photos:
Waiver Attached:
yes no
yes no
yes no
yes no
.lj
I]-
II
Agent or Applicant Printed Name
Signature x* Please read compliance statement on back of permit **
PermitOfficer's Printed Name
Signature
Application Fee(s)Check #lssuing Date Expiration Date
Street Address/ State Road/ Lot #(s)
)(Scale:
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Abuildingpermitmayberequiredby'.trSeenoteonbackregardingRiverBasinrules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
nullandvoid.
This permit must be on the project site and accessibletothe permit oflicerwhen the prolect is inspected forcomPliance. The
applicant certifies by signing this permit that l) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this proiect is consistent with the local land use Plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adiacent riParian
landowner(s) .
The State of Nonh Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and beliet certirythatthis project is consistentwith the North Carolina Coastal Management Program.
River Basin Rules ApplicableTo Your Proiect:
E Tar- PamlicoRiver Basin Buffer Rules
f -] Neuse River Basin Buffer Rules
E other:
lf indicated on front of permit, your project is subiect to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Retional Oflice (252-946-6481) or the
Wilmington RegionalOflice (91 0-796-7715) lor more information on howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
2s2-808-2808/ r -888-4RCOAST
Fax: [phone]
(Sewes: Caneret, Craven, Onslow -
Nonh of New River lnlet- and Pamlico
Counties)
Elizabeth Citv District
401 S. Griffin St.
Ste. 300
Elizabeth Citf, NC 27909
2s2-264-390t
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquoank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax:252-948-M78
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
I 27 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-7215
Fax: 9 l0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
hft p://portal.ncdenr.orglweb/cm/dcm-home
Revised 7/06/ I 7
T
I hereby cediry that I own property adjacent to o.rk-
property located at t of
(Address,
s
e
, N.C
S
Block.
PK , otc.)
on ,tn(Waterbody) '
1-Citynown anOlor eountyl
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAwlNG OF PROPOSED DEVELOPIUIENT
(lndhttdual prcpocing devalopment muat llll ln descrlption below of
,atbch
a site clnwlng)
I )*bry v&er W- t l\eh,ih*d5D\
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n)
t
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l6v ljx 3' zt ls r.J1- pae+-1,
z5* t3+ j' 3t,
[hvroct
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I understand that a pier, d
lflAffitEffier-
ng pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15'from my ar€a of riparian access unless waived by
me. (lf you wish to waive the setback, you must initial the appropriate blank below.) RECEIVED
I do wish to waive the 15' setback requirement.
JUN 2 5 2021
I do not wish to waive the 15' setback requirement.
x/+
ock/ mootri
(Pro
uliaFoclio{-
(Adjacent Property Owner
s
Pint or Type
Do
ITY
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n
sl
A
orX f // c 7"dz
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'Valid for one calendar year after signature'
Llb Y€
/ email add,ess
b
Dqte Date
4
(Revised Aug. 2014)
aa/on
\L
2t
\d,
address
fk-I hereby certify that I own property adjacent to a'e
property located at
(Addreos,, tr.)
tn K(. N.C
The applicant has described to me, as shown below, the development proposed at the above
'% I have no objection to this proposal.
I have objections to this proposal.
DESGRIPTION AND'OR DRAWNG OF PROPOSED DEVELOPTENT
(lndfuldud ptoposing dwelopment muct f,ll ln dar;crlpilon below oy,atbch e sitn &awtngfi\t I
t\.
of
on
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Nl/A@
oocKr roonn!1il-g., oou, ,"-p,I understand that a pier,brealuater, boathouse, lift, or groin
must be set back a minimum distance of 15'from my area of riparian access unless waived by
me. (lf you wish to waive the setback, you must initial the appropriate blank below.) RECETVFp
ldo wish to waive the 15'setback requirement.
JUN 2 5 2021
I do notwish to waive the 15'setback requirement.
DC M-Ml{Ft CITY
utia
(Adlacent Property Owner lnformationr)
1/^tL 1,0
l. ^ochel t@B',,(ir^ ?o.tko
P{-lnq{t c0 1A0E-
lqO fvu,or'( ' o*2
address Numbar / email addmss
laqt>lTelephone
Q
ralonAar vaar afrFrr sionature'
Date'
(Rew.sedAug. 2014)
(Waterbody)
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Date
L5z-4q - q#-1