Van Noy, Tim

AMA / [:]DREDGE & FILL N9 78435 A B D
IG -NERAL PERMIT Previous permit#
jm
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 1 // /
and the Coastal Resources Commission in an area o e vironmental concern pursuant to I SA NCAC c
�.✓
les attached.
_1
Applicant Name i 1 / ' Project Location: County (✓Gl,(("r "'A
Address Street AddrJes/s/ State Road/ Lot #(s)
City, (A j< I' ' StateA/ IP
Phone # &/_MM_Mail Subdivision
Authorized Agent Ciry 'l` I'` �r ZIP
wFPTA ❑Es ❑PTS Phone# ( ) River Basin
Affected[I OEA HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body i jr tn. �P na man unkn
❑ PWS:
ORW:�es,/�no PNA yes noj ClosestMaj.WtrBody
Type of Project/ Activity b /` / Y1 U Gf UC
ISx/l
Pier (dock) length_
Fixed Platform(s) 0
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ ftiprap le
avg distance o
max distance i
Basin, channel
Boat ramp
Beach Bulldozing
Other
i
i
Shoreline Length C it
SAV: notsure yes noj
Moratorium: n/a yes no
Photos: yes o, _
Waiver Attached: yes no,
e
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
(Scale: '5)
❑ See note on back regarding River Basin rules.
Permit ni ers �nnpeo LName
Signat$re %** Please read compliance statement on back of permit
)**
Application Fee(s Check#
/ )

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Timothy G. and Linda M. Van Noy s
property located at Lot 31, 1659 Island Road (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on Back Sound , in Harkers Island N.C.
(Waterbody) (Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to ion.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill In description below or attach a site drawing)
p.er lrf
200
OAA
15L�Ad
WAIVER SECTION
I understand that a 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. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
j_ I do not wish to waive the 15' setback requirement.
(Property Owner
Timothy G. Van Noy
Print or Type Name
101 Saddle Ct.
Mailing Address
Mullica Hill, NJ. 08062
City/State2ip
609-439-8327 / [e-mail]
Telephone Nymber/email address
j/p /z.o/9
Dare
'Valid for one calendar year after signature`
(Revised Aug. 2014)

.A
LD
fn
�
m
N
O
N
�
a
-
co
t
0
E
0
4.—
a
O
*'
M
U
0
w
O
U
N
C
"
4-
ca
t-
C
cv
0
�O
Q
CO
EE=�=
a)
C
U
00
v--
O
O
4
'cc
Q
>'
a
E
=+L•
c
o
U
a.w<o
•!M
5LRv, -IN
Y'
R,
N
cl
WTT
W
Q ® fjC
C0V)
��p
U N
�
ai
7 7 c�cpp
�QQCJ
Qq :3
c
:3
c
UU
ri❑❑❑❑❑❑
It
0)
LO
0)
IQ;
i
6
a
t
M
{i
c
4
U
a�
0
a
Ln 0
rw
p— Q
CD
Ln
N
rq O
LO
-r z
to ,
Cl T--
CD
® N
ca �
00
� r
. Cl
(l (o
P- E
rq LL.
�a

1659 Island Road, Harkers Island, NC
Sketch of Proposed Dock on Back Sound
(Not to scale; dimensions are approximate)
10,000 lb boat lift
lock, leNirO Z11o'
a- 1 S 2 p
H
31
— 2 sections of hog salt added to make
last 20 feet of dock double width
Dock to align roughly parallel with west
property line resulting in approximately
70 feet between this dock and Davis
dock at the end of Davis dock.
Dock starts 31 feet from center
line of road and is located 35 feet
off neighbors bulkhead.
'4%
3�w
`�fzoPEe'r l L„JE

n
0
z

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 11654 Sst a.. n Q s. u 17si.04js aL
Mailing Address: IA' ( o t wo G
Phone Number:
Email Address:
I certify that I have authorized
A,A�t_t_tc.a- �k,`\ 01 t)0&/o6 z.
YAe
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: wL f %30 L�f
at my property located at !L 94jake2s Xik .. r, 0L
in &rsT6P2jT-T— County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Si atu/re
0*1
riot or Type Name
d WAJ &1Z
Title
/ I / Z I 'Zo ZD
Date
This certification is valid through / /