Form: Fisheries and Oceans Canada Notification Form

NOTIFICATION FORM

Version 3.1

Select Operational Statements that are being used (check all applicable boxes):

• Aquatic Vegetation Removal in Lakes
• Bridge Maintenance
• Culvert Maintenance
• Directional Drilling
• Dock and Boathouse Construction in Fresh Water Systems
• Dry Open-Cut Crossings
• Ice and Snow Fill Bridges
• Isolated Pond Construction
• Maintenance of Riparian Vegetation in Existing Rights-of-Way
• Overhead Line Construction
• Public Beach Maintenance
• Punch and Bore Crossings
• Routine Maintenance Dredging for Navigation
• Small Moorings
• Small Clear-Span Bridges
• Temporary Ford Crossings
• Underwater Cables in Fresh Water Systems

Select the type of water body or watercourse at or near your project:

• River, Stream, Creek
• Lake (8 hectares or greater)
• Marine (Ocean or Sea)
• Estuary
• Pond or wetland (pond is less than 8 hectares)

Project Details

• Name of water body or watercourse: Portage Inlet
• Nearest Town to site: View Royal, BC
• Legal Description (Plan, Block, Lot, Concession, Township, Section, Range): Lot 2, Section 9, Esquimalt District, Plan 15774 PID: 004-564-405
• Coordinates of the Project (UTM co-ordinate or Degrees, Minutes, Seconds), if available:
  • Easting:
  • Northing:
  • Latitude:
  • Longitude:
• Directions to Access the Project Site (i.e., Route or highway number, etc.): North on Highway 1 to Helmcken exit into View Royal.
• Proposed Start Date (YYYY/MM/DD): 2014-01-01
• Proposed Completion Date (YYYY/MM/DD): 2014-09-01

Please notify DFO, preferably 10 working days before starting your work, by filling out and sending in, by mail, email or by fax, this notification form to the DFO Regional Headquarters. This information is requested in order to evaluate the effectiveness of the work carried out in relation to the Operational Statement.

I, Whitney Garside (print name) certify that the information given on this form is, to the best of my knowledge, correct and complete.

Date: 2013-10-17

Note: If you cannot meet all of the conditions and cannot incorporate all of the measures in the Operational Statement then your project may result in a violation of Subsection 35(1) of the Fisheries Act and you could be subject to enforcement action. In this case, you should contact the DFO office in your area if you wish to obtain DFO's opinion on the possible options you should consider to avoid contravention of the Fisheries Act.

Information about the above-noted proposed work or undertaking is collected by DFO under the authority of the Fisheries Act for the purpose of administering the fish habitat protection provisions of the Fisheries Act. Personal information will be protected under the provisions of the Privacy Act and will be stored in the Personal Information Bank DFO-SCI-605. Under the Privacy Act, individuals have a right to, and on request shall be given access to, any personal information about them contained in a personal information bank. Instructions for obtaining personal information are contained in the Government of Canada's Info Source publications available at www.infosource.gc.ca or in Government of Canada offices. Information other than "personal" information may be accessible or protected as required by the provisions of the Access to Information Act.

This Notification Form (Version 3.1) may be updated as required by Fisheries and Oceans Canada. It is your responsibility to use the most recent version. Please refer to the Operational Statements web site at http://www.dfo-mpo.gc.ca/oceans-habitat/habitat/modernizing-moderniser/epmp-pmpe/index_e.asp to ensure that a more recent version has not been released.