Gagnon, Chris 79566C

trCAMA/IDREDGE&FILL
ENER/AL PERMIT
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 pursuant
Applicant Name
Address
State
Phone # (__ )
N979566 A B c D
Previous permit #
Date previous permit issued-
to l5A NCAC
D Rules attached.
Proiect Location: County
Street Address/ State Road/ Lot #(s)
E-Mail Subdivision
Authorized Agent
Affected ! clv
AEC(s): troEA
L]PWS
ORW: yes / no
City ztP
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affa
ntH
nES
N UBA
N PTS
t] N/A
River Basin
Adj. Wtr (nat /man lunkn)
Closest Mal. Wtr. BodyPNA yes / no
xt (Scale:)
Type of ProiecV Activity
Pier (dock) length
Fixed Platform(s) .
Floating Platform(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore_
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing_
Other
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Shoreline Leneth *
SAV: not sure
Moratorium: nla
Photos:
Waiver Attached:
yes
yes
yes
yes
A building permit may be required by:
( Note Local Planning Jurisdiction)
E S"" note on back regarding River Basin rules.
Notes/ Special Conditions
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Agent or Applicant Printed Nanre PermitOfficer's Printed Name
Signature xx Please read compliance statement on back of permit **Signature
Application Fee(s)Check#lssuing Date Expiration Date
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Phone # (_)
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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 permiftee to a fine or criminal or civil action; and may cause the permit to become
nulland void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I ) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project 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 adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
I Tar - Pamlico River Basin Buffer Rules
I Nerse River Basin Buffer Rules
I other:
lf indicated on front of permit, your project is subject 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 Regional Office (252-946-6481) or the
Wilmington Regional Office (910-796-721 5) for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
2s2-808-2808/ | -888-4RCOAST
Fax:[phone]
(Serves: Carteret, Craven, Onslow -
North of New River lnlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-390t
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax:[phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
910-796-72t5
Fax: 9 I 0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://portal. ncden r.orglweb/cm/dcm-home
Revised 706l I 7
/TDREDGE&FILL
ENER/AL PERMIT
ew EModification EComplete Reissue EPartial Reissue
fu authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant
N9 79566 A BCD
Previous permit # _
Date previous permit issred_
to l5A NCAC
Applicant
Address
Name
E Rules
Project Location:
Street AddresV Stateload/ Lot #(s) ,.
State__ztP t1t
Phone # ( )
Authorized Agent
E-Mail
ZIP
Affected tr cw Il Ew fl PTA
AEC(s): oEA HHF lH
L ] PWS:
ORW: yes / no ,,*O *, I ,o
trES
tr UBA
N PTS
!N/A
Phone# (-) RiverBasin
Adj. Wtr
Closest Mai. Wtr. Body
(nat /man /unkn)
)C
Type of ProjecV Activity
I xl(I (Scale:
I S"" note on back regarding River Basin rules.
)
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin len6h
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Moratorium:
Photos:
Waiver Attached
A building permit may be required by:
( Note Local Planning Jurisdiction)
nla yes no
yes no
i yes no
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Notes/ Special Conditions
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Agent or Applicant Printed Name
Sigirature ** Please read compliance statement on back of permit x*
Permit Offi cer's Printed Name
Signature
vt., I
Application Fee(s)Check #lssuing Date Expiration Date
Subdivision
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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
nulland void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I ) prior to undertaking any activities authorized by this permit, the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all loca!
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The Sate of North Carolina and the Division of Coasal Management, in issuing this permit under the best available
information and beliet certiry that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
E far - Pamlico River Basin Buffer Rules
I Neuse River Basin Buffer Rules
E other:
lf indicated on front of permit, your project is subject 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 Regional Office (252-946-6481) or the
Wilmington RegionalOffice (910-796-721 5) for more information on howto complywith these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters
400 Commerce Ave
Morehead City, NC 28557
252-808-2808/ | -888-4RCOAST
Fax:[phone]
(Serves: Carteret, Craven, Onslow -
North of New River lnlet- and Pamlico
Counties)
Elizabeth City District
401 S. Griffin St.
Ste. 300
Elizabeth City, NC 27909
252-264-3901
Fax:[phone]
(Serves: Camden, Chowan, Currituck,
Dare, Gates, Pasquotank and Perquimans
Counties)
Washington District
943 Washington Square Mall
Washington, NC 27889
252-946-6481
Fax:[phone]
(Serves: Beaufort, Bertie, Hertford, Hyde,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext.
Wilmington, NC 28405-3845
9t0-796-7215
Fax: 9 I 0-395-3964
(Serves: Brunswick, New Hanover,
Onslow - South of New River lnlet-
and Pender Counties)
http://portal. ncden r.org/web/cm/dcm- home
Revised 7/06/l 7
Name of property Owner Requesting permit:
Mailing Address:
fuE Number:
Email Addrcss:
I certify that I have authorized
ryery,"J,
frte
to act on rny belraif' for the purp*e of applying for and ob*aining all CAF{A Fennits
recessary tur the fotkrying fopo$€d devdoprrent A;*{ *p* ;t{* - -_
at my property bcated at
Proporg
Srynalrre
Prinl u Nama
I furthesrwre certify that I am autharized to grant, and da {n fir..;t grant perrnission toavisbn of coa$at Managenant statr, t e L;d p;rnit otrre, ar* thek age'tts fo enferon the afareme*tioned lands in canne#iion wfirr eva*atlng informationre/afed fo firispermit applicatbn.
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Dde
This certificatbn is valid through __t**-J*W *
;n dt$ _county.
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DIVISIOil OF COASTAL TIANAGETIENT
ADJACEilT RIPARIAN PROPERTY OTI'}TER ITOTIFICAT|0NflfUAIVER FORII
Narne of Property Owner:rL
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Address of Property: tnl *ra'<.^ D r , t4xrk-eq- t<,r*r|. ,Yr Ag V t
(Lot or Steefi *, Sfreet or Road, Crty & Corlnty) C* ee* (at^**7
*prmcantprrone *'" - 3Qt-- 3V 3'-35t. MaitlrsAddress: Ji Y? wro.Iqo,r:.e P 1
I harcby certifu
applying tur this
that I own property adjiacent to the above refuranced property. The individuat
0n
they are proposing.
-L I have no objecuons to thi.s p{opo$el. i haVe objqqtlsn$&o this proposa}.
tf yauhave.abiec{fons to whatistutngplo,gps_9d,E7u 1y111sytngttfVtfie&iebn dCoas{af ttienaganrent(ffi ln rrryltlng wft'atn 1o days d r*d$ of thE no?ct. Canarct ir&rrrraf6}t"Ww 6*tgts-ts
araafiable at w,nccoasblmangenwrLfiet/conhd_dcm,htm ar by cdling 'td/8f.-t*f,;OAsf. ,Vo
ressoase q cs?s*rercd rhe sarn6 as rro ot*scthn if v8., ,rave oeen notffi &y cerrilM firiL
TYATVERSECTIOTT
I understand that a pier, dock, mooring pilings, brealouater, boathouse, or lift must be set back a
minimum distance of 15'frcm my area of riparian access unleqs waived by me. (tf pu wish to
waiw the setback, you rpust i{rrXBl the appropriate blank below.)
ldo wish to waive the 15'setback reguirernent,
\I do not wish to waive the 15'setback rcquirernent.
Owner Owner lnformation)
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Twe Print ar Type Nama
Mailing
\\\iiYa\\\
as<i1
Tetephone Number
q.ila
Teleghane Numfrer
Date Date
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cERTtFrEp rf,AtL . RETpRN RECEIPT REOUESTED
DIVISiION OF COASTAL IIANAGE}IENT
ADJACENT RTPAFIIAN PROP ERTY OW}IER NOTI F EAT]ONIWAIVER FORM
Name of PropeQ Owner Chrrl,h.r Scr*t/^ { Su^o^
Address of Property:n I Brrn lo- 0r. f|.f I,{,c- 2{rl b&Et h*11
(Lot or S;teet #, Street or Road, Oity & County)
fc"ttAgent's Name #:
Agenfs phsne #:
nay\MailingAddress:L&lr bo*lcacL N
3 o I - 3-t 3 -0rr1, !3{-tr.rrl lt*' ,Vk aqr?o
I hereby certry
applying for this
that I own property adiacent to the above referenced property. The individual
has to me as shown on
ffo
they are proposing.
X I have no objections to this proposal. I have objections to this proposal.
lfyouhaveobi*lions&whatisbingproposed, pumustnotifyrlheDhrisionoffusblllanaganent
(DCtJl) ln writing wtthin 1o days of rccoipt of tlris notice. Conbct information flrr DCtt ofitrces is
available or by ca I I i ttg i-88&4RCOASI.
WAMER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boailrouse, or lift must
be set back a minimurn distance of 15'from my area of riparian acces$ unless waived by me. (lf
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15'setback requirement.
the same
(Property Orner lnformatio n)
Prirrt or Name
nt 8"6,^-k [riw
Mailing Address
l{.ruos Tl*a., N. (. ll ril
City/StaterZip
?ol t-n qU
Telephone Number / EmailAddress
S-il-rt
Property Owner lnformation)
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Pint or Type Name
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Telephone Number / Email Address
3b .<orl
Date
(Revised Aug. n14)
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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERW OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL . RETURN RECEIPT REQUESTED oT HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:tt
Address of Property:
Owner's email:Owner's Phone#:
Agent's Name: l/,'ltt fimraio Agent enone*: l5Z, 1/ 1 . 1o ftc)
Agent's Email:
ADJAC ENT RI PARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed bv the Adiacent Prooertv Owner)
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this
permit has described to me, as shown on the attached drawing, the development they are proposing. A
description or drawinq. with dimensions. must be orovided with this letter.
V I DO NOT have objections to this proposal.
-
I DO have objections to this proposal.
you obj*tions to what is being you must notify the N.C.
Management (DCM) in wrtfing within l0 days of receipt of this notice. Con*pondence should be
maildtotl(N CommerceAve., Morehead City, NC 28557. DCM rcpresentativescan also becontacted
at (252) 808'2808.I11o response is considercd the same as no objection if you have been notified by
Certified Mail.
WAIVER SECTION
I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
groin must be set back a minimum distance of 15'from my area of riparian access unless waived by me
(this does not apply to bulkheads or riprap revetments). (lf you wish to waive the setback, you must siqn
the appropriate blank below.)
I DO wish to waive some/allof the 15'setback
Signature of Adjacent Riparian Property Owner
-oR-
I do not wish to waive the 15'setback requirement (initial the blank)
Signature of Adjacent Riparian Owner:
il
&Fr"ilrk)
\15Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's emai!:
<q Hq
cc,4{L lnPo's Phone#:fl 5l -725 5 {55
neviseflApilYFn
c 3853 (
JUL 2 3 2021
DCM-MHD CITY
Mailing Address of Owner: .< qn 4
F #y e,,ag,:n't / u t 1r zlz ,Ds?-
x}(R
o^t", //ATiaD \ -*aiver is vatid for up to one year from ARpo,s Signature.
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