89054A - Fortin, Michael and Cindi

❑DREDGE & FILL N0 89054 A, B C D
Previous permit
_' GENERAL PERMIT Date previous permit issued
NNew ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State of North Gsrolina. Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
ISANCAC r/7-t7D ❑Rulesattached. E Ga ral Permit Rules available at the following link vn Aeo.nc.eodCAMArules
f_
Appliwst Name �c Z( g--� i !'f`I1 Authorized Agent
Address v, /.SAY S 3 Proles Location (County): � 6-r1
City 5fu-0.-7 05 i+'!°` State VIA' zip 'LY`t 77 Saeet Address/State Ro/ad/L-of#(s) S R /(Z9,Y/ Gef Z-7
Phone # in�) i-55- 7 /7 (4 5/1 ? 2 WIS 5-f'e-t" L4. n •
Email Yh r���+� IQ C\4y s'Gs-�= "��VA'n Subdivision W i A « - Ll c(-Vo-^ S A -rk S
City C. zip 2�75
Affected ❑CW PTA ❑ES ❑PIS Adj. Wtr. Body <S�((cla / � )j (.W unk)
AEC(s): ❑OEA ❑IHA ❑uW ❑SPIMA ❑PWS Closest Mal. WV. Body /0<t. AG>
ORW: yes/(o : PNA: yes/c.
of Project/Activity
Access Length
Pier (dock) length _
Fixed Platform(s)
Floating Platform (s)
Finger piers) -3
Total Platform area
Groin length/g
Bulkhead/ Ripmp length
Avg distance offshore _ -
Brealovater/Sill - -
Max distance/ length
Basin, channel _
Oubicyards
Boat mmp
Boathouse/ Boatlifi
Beach Bulldozing
Other i
G��r(
SAV observed: yes no
Moratorium: n/a yes no
Site Photos: yes- no
Riparian Waiver Attached: es no 4-.
A building permit/zoning permit may be required by: �D o-r
a
Si! p
IS TMS to- fuc/-'
I=
Sig ature lease feadcompliance statement on back of permit•'
Application Feels) Check W/Money Order
(Scale: N—j5 )
--rL _1._...
l - D
F��T .
Pr_
❑ TARMAN/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
JD RENEWED COMPLIANCE STATEMENT. (Please Initial) i�-
Y J.n C.U{Ver
Permit Officer's PRINTED Name
sigyture
LF /Y /Z�( Y
Issuing Date Expiration Date

CAMA ❑ DREDGE & FILL N9 89054 G B C D
Previous permit
pt 4�
EN ERAL PERMIT Date previous permit issued
}New ❑ Modification ❑ Complete Reissue ❑ Partial 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 to:
I SA NCAC 7i/'2 ,a ❑ Rules attached.Eil-Ceneral Permit Rules available at the following link: www.deo.nc.gov/CAMArules
Applicant Name '4—CJ Authorized Agent
Address l � D r /5oPt 7 03 /L -7 Project Location (County): ,f
City 51 U,0,(� (�o� State VA zip � yq 7 / Street Address/State Road/Lot #(s)/ S-Q /' Z 9 �� Z-
Phone # (-W"l) L- $.S ^ % 17 � t ) 5 / / 7 Z_ /�S ) *V- (Q., n ,—
Email ihT or^ft.^ 8 014 V o.+cSubdivision C, - (-e
City zip
Affected ❑ CW �61AL PTA ❑ ES ❑ PTS Adj. Wtr. Body. (nat/ a' /unk)
AEC(s): ❑OEA ❑IHA ❑UW ❑SPIMA ❑PAIS Closest Maj. Wtr. Body %0..Iil./t ro,
ORW: yes/�io PNA: yes/�- )
of Project/Activity =A 5 %a I I /G, JC / 2
Access Length
Pier (dock) length
Fixed Platform(s) A0
Floating Platform(s)
Finger pier(s) 3 ' Y� z-...S
Total Platform area 9 �-
Groin length/M
Bulkhead/ Riprap length
Avg distance offshore —
Breakwater/Sill —
Maxdistance/length -
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlik
Beach Bulldozing
Other
SAV observed: yes no.
Moratorium; n/a yes no
)
Site Photos: yes no
Riparian Waiver Attached: es no
NL
A building permit/zoning permit may be required by: V
Permit Conditions
3�x
c aA-��
.5/i 11
F!�, P 7-/ f )
y ,
=:r A t-r
P�-
(Scale: ,v jj )
•
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
0
Agent or Applicant PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Feels) Check It/Money Order
Permit Officer's PRINTED Name
�
Si &ure
C,/Y/zY i t-/v /2Y
Issuing Date Expiration Date

AtA "te"r', ❑CAMA ❑ DREDGE & FILL N9 89054 A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial 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 to:
15A NCAC ❑ Rules attached. ❑-General Permit Rules available at the following link: www.deq.nc goy/CAMArules
Applicant Name _
Address
City
Phone # (_ )
Email
ZIP`
Authorized Agent -
Project Location (County): )...
Street Address/State Road/Lot #(s)
Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ pT5 Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA! yes/no
Type of Project/ Activity f
(Scale: )
Access Length
Pier (dock) length
L
Fixed Platforms)
Platforms)_
'.
i
Floating Platform(s)
Finger pierls)
Total Platform area
_
-!
!
..
I'f
OL-
Groin length/#
'
Bulkhead/Riprap length
-
,.
-_I
—
—!
-
-_.
_.�.__
_
Avg distance offshore
1
--
'�r
-�----------
—
_
Breakwater/Sill
i
Max distance/length
I_
�-
"
T-
—
Basin, channel
'..-
-
Cubic yards
C
I
I
I
1I
Boat ramp
I
Boathouse/ Boatlift
Beach Bulldozing
Other
T___
SAV observed: yes no
Moratorium: n/a, yes no
Site Photos. J yes no
I
- - -
-
—
-
H
I
Riparian Waiver Attached: yes no
;
C-�~
A building permit/zoning permit may be required by: D n..' a -(
Permit Conditions
❑ TARJPAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
1 AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
x.
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
v..
Signature "Please read compliance statement on back of permit•- Signature
Application Feels) Check #/Money Order Issuing Date Expiration Date

Frisco, NC 27936
Parcel: 011678000
Pin: 051614446850
Tax District: Frisco
Subdivision: Wind -haven Shores
Lot BLK-Sec: Lot: 27 Blk: Sec:
Property Use: Secondary Improvement
Building Type:
Year Built:
Tax Owners: Fortin, Michael A -Primary Owner, Fortin, Cynthia B -Primary Owner -Primary Owner
Mailing Address: P. O. BOX 903 Stuarts Draft VA 24477
Building Value: 0
Land Value:93,600
Misc Value: 11,800
Total Value: 105,400

37'
25'
12'

re AP
}' •
':3"
4
y
r
r

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner:
Address of Property:
Mailing Address of Owner:
Michael and Cindi Fortin
51172 Lassiter Lane, Frisco, NC 27936
PO Box 903, Stuarts Draft, VA 24477
Owner's email: mfortin@advanced-telephone.80wner's Phone#: [phone]
Agent's Name: N/A
Agent's Email: N/A
Agent Phone#: N/A
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom portion to be completed by the Adjacent Property 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 drawing with dimensions must be provided with this letter.
y I DO NOT have objections to this proposal. I DO have objections to this proposal.
If you have objections to what is being proposed, you must notify the N.C. Division of Coastal
Management (DCM) in writing within 10 days of receipt of this notice. Correspondence should be
mailed to 401 S. Griffin St., Ste. 300, Elizabeth City, NC, 27909. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection if you have been
notified by Certified Mail.
WAIVER SECTION (Choose only one)
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). (If you wish to waive the setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15' setback
-OR-
Signature of Adjacent Riparian Property Owner
I DO NOT wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner: � , ,. L-f ,,_ ,
Typed/Printed name of ARPO: Brad dameron / e
Mailing Address of ARPO: 7024 gate city hwv bristol va 24202 �
ARPO's email: dameronelectricllcUyahoo corn ARPO's Phone#: [phone]
Date: 5/10/24 *waiver is valid for up to one year from ARPO's Signature*
Revised August 2022

958 22 22 2668914 2
Cf-)

Carver, Yvonne
From:
Sent:
To:
Subject:
Attachments:
Good morning Mr. Fortin,
Carver, Yvonne
Wednesday, June 5, 2024 10:18 AM
Mike Fortin
GP89054
Fortin GP89054.pdf, FORTIN RECEIPT.pdf
A copy of general permit (GP) number 89054 authorizing your docking facility project in
Frisco is attached for your review and signature. A copy of your receipt is also attached.
To validate this permit, please address the following:
1. print and sign the permit on the bottom left-hand corner belowyour printed name,
2. initial where indicated on the bottom right of the permit, and
3. scan and send a signed copy of the GP back to me.
Please contact me if you have any questions.
Thankyou.
Yvonne B. Carver
Environmental Specialist II
Division of Coastal Management
NC Department of Environmental Quality
252-621-6453
401 S. Griffin St., Suite 300
Elizabeth City, NC 27909
t

m � .
;, ., ,
,.... .
'
�
,j
a�. ;_
` �-l!
a"
�
,�tx
� _ � -,
-...lrpj3�,•