APPLICATION TO CONSTRUCT A DOCK. (In Accordance with Orange County Code Chapter 15, Article IX, Orange County Code) SECTION 1

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1 ORAN E C UNT1 v GOVERNMENT liorin A APPLICATION TO CONSTRUCT A DOCK (In Accordance with Orange County Code Chapter 15, Article IX, Orange County Code) Mail or Orange County Environmental Protection Division Deliver To: 800 Mercy Drive, Suite 4 Orlando, Florida (407) , Fax (407) **Filing fee of $ payable to The Board of County Commissioners** **Process fee for Appeals and Variances: $409.00** OWNER(S) OF THE LAND Name: Tide and Company: Address: Woodrow Owen 1439 Lake Whitney Drive SECTION 1 City: Windermere State: Florida Zip: Telephone and Fax: (407) ENTITY TO RECEIVE PERMIT (IF OTHER THAN OWNER) Name: N/A Title and Company: Address: City: State: Zip: Telephone and Fax: AGENT/CONSULTANT AUTHORIZED TO SECURE PERMIT Name: Sheila Cichra Title and Company: President. Streamline Permitting, Inc. Address: 2154 Oak Beach Blvd. City: Sebring State: FL Zip: Telephone and Fax: (407) CONTRACTOR (IF DIFFERENT FROM AGENT) Name: Albert Cichra Title and Company: Albert Cichra Builders, Inc. Address: Marine Drive sheilacichra@gmail.com City: Orlando State: FL Zip: Telephone and Fax: (407) (407) cichra@bellsouth.net Dock Construction Application Revised 781/13 Page l of 5

2 SECTION 2 - GENERAL INFORMATION Street Address: Deer Isle Circle Tax Parcel ID 30 _ 22 _ 27 _ 1985 _ 00 _ 560 Legal Description: Meets and bounds - basically, lot 56. Deer Island as per PB 15. p 63 Name of water body: John's Lake Normal High Water Elevation (NHWE): msl Is the proposed dock? Please check one: 4/ Private Semi-Private Public What is the width of the shoreline (in linear feet), as measured at the NHWE? 122' feet. What is the size of proposed terminal platform? 7 4/4 square feet. [See Chapter 15; Article IX; Section (b)1 Are you requesting a variance? Yes 1/ No Are you requesting a waiver? Yes / No If yes, provide section Number: 15 - (example: ) and describe the nature of the variance and/or waiver request: Note applications for a waiver and/or variance from the boat dock ordinance will require the completion of a separate waiver and/or variance application and may require additional fees. If you have questions, please call EPD for assistance. Brief Description of proposed work: 4' x 170' dock, 12' x 30' deck, 12' x 11' PWC slip and 13' x 24' boathouse Are there docks on the abutting properties? 4/ Yes Are there any access restrictions to the property (locked gate/loose dogs): No no REQUIRED ATTACHMENT(s) CHECKLIST: Cif Satisfactory evidence of title. (Example: copy of property deed). 51 Documentation showing riparian rights for the parcel. 2 A copy of a survey, to scale, of the real property which accurately depicts current conditions. 51 Four (4) copies of a site plan depicting the exact location of the proposed dock, and shall include the following: An arrow indicating the northerly direction of the scale to which the sketch or drawing was prepared. The name of the water body upon which the proposed dock structure or renovation is to be located. The exact distance between the shoreline and a permanent object or construction. The exact setback distance from adjacent property lines and projected property lines to all portions of the dock. The floor and roof elevations of the proposed or existing dock. The current water depth at the end of the proposed or existing dock, and at all proposed mooring locations. The length of the proposed or existing dock, as measured from the NHWE to the point most waterward of the NHWE. Dock Construction Application Revised 7/31/13 Page 2 of 5

3 U U U U U The MIWE as established by the county shown property survey as field verified by a professional surveyor. The location of any conservation easement areas and wetlands within twenty feet from any portion of the dock A description of vegetation types identified occurring within twenty feet from any portion of the dock The location of any lifts. hoists, mooring pilings and mooring areas A mitigation plan offsetting adverse impacts to the conservation easement areas or wetlands lif applicable) U U A description of sedimentation and erosion control measures used during construction and/or repair of the dock AGENT AUTHORIZATION FORM PERSON AUTHORIZING ACCESS TO THE PROPERTY MUST COMPLETE THE FOLLOWING: I either own the property described in this application or I have legal authority to allow access to the property and I consent to any site visit on the property by agents or personnel from Orange County, Florida necessary for the review and inspection of the proposed project specified in this application. I authorize these agents or personnel to enter the property as many times as may he necessary to make such review and inspection. Further. I agree to provide entry to the project site for such agents or personnel to monitor permitted work if a permit is granted. Woodrow Owen Typed/Printed Name Signature Date Corporate Title (if applicable) By signing and submitting this application form, I am applying for the permit identified above, according to the supporting data and other incidental information filed with this application. I am familiar with the information contained in this application, and represent that such information is true, complete. and accurate. I understand this is an application and not a permit, and that work conducted prior to approval is a violation. I understand that this application and any permit issued pursuant thereto, does not relieve me of any obligation for obtaining any other required federal. state. water management district or local permit prior to commencement of construction. I understand that Orange County will make no representation as to the proposed dock's impact on navigability or safety. For that reason, I understand that it may be advisable for me to consult with an expert in navigability and safety issues. I agree, or I agree on behalf of my corporation, to operate and maintain the permitted system unless the permitting agency authorizes transfer of the permit to a responsible operation entity; 1 understand that knowingly making any false statements or representation in this application is a violation of Sections & Orange County Code. Typed/Printed Name of Applicant Sheila Cichra Signature of Applicant/Agent Date - 7 / 2 /// President. Streamline Permitting. Inc. Corporate Title (if applicable) Dock Construction Application Revised Page 3 of 5

4 SECTION 3 Name and Address of adjacent property owners: Name: Mount Zion Assembly of Apostolic Faith Church Address: Po Rox City: Winter Garden State FL Zip Name: Cheryl Taylor Trust Address: Deer Isle Circle city: Winter Garden State FL Zip NOTICE TO APPLICANTS: The proposed dock structure may require a permit from either the Florida Department of Environmental Protection or the applicable Water Management District. In addition to public regulations which Orange County enforces, be advised that there may be other private restrictions or approval requirements that will affect your ability to erect this structure. Please review your deed restrictions and/or consult with your Homeowner's Association or Architectural Review Board Dock Construction Application Revised 7/31/13 Page 4 of 5

5 AGENT AUTHORIZATION FORM FOR PROJECTS LOCATED IN ORANGE COUNTY, FLORIDA I/WE, (PRINT PROPERTY Woodrow Owen PROPERTY DESCRIBED Deer Isle Circle AUTHORIZE TO ACT AS MY/OUR AGENT 7-0 Lt. \ ture of Prope y OWNER NAME) AS THE OWNER(S) OF THE REAL AS FOLLOWS,, DO HEREBY (PRINT AGENT'S NAME). wner C N GOVERNMENT F 1. U R 1 I) A Sheila Cichra TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE APPLICATION APPROVAL REQUESTED AND MORE SPECIFICALLY DESCRIBED AS FOLLOWS, Boat Dcok Permit, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY CONSIDERING THIS APPLICATION AND TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THE APPLI ATION. ).1 C Print Name Property Owner Date: Date: Date: STATE OF FLORIDA COUNTY OF ORANGE Signature of Property Owner Print Name Property Owner Signature of Property Owner Print Name Property Owner Signature of Property Owner Print Name Property Owner certify that on 7) :Mitt, before me U A /-1000e1 1 an officer duly authorized by the State of Florida and in the county mentioned above, to take acknowled gements, personally appeared N.NIceckvoid Wein, to me knowyt to be the person described in this instrument or to have produced, as evidence, --IiWaxi v has acknowledged before me that he or she executed the instrument and did / did not take an oath. Witness my hand and official seal in the county and state stated above on the r.vois in the year 2014 Signature of Notary Public (Notary Seal) Notary Public for the State of Florida Notary Public State of Florida Tammy D. Howell Mt. Commissar) FF Expires 07/04/2017 My Commission Expires: Legal Description(s) or Parcel identification Number(s) are required: PARCEL ID #: LEGAL DESCRIPTION: Lot 56, Deer Island as per Plat Book 15, Page 63 - full legal follows DEER ISLAND 15/63 LOT 56 & A PT OF GOV LOT 5 SEC DESC AS: BEG SE COR OF SAID 1 I 1 - " I ; -. Ii a, a a a a, a- a, - -,, - - a a, -, p..,. 4NTERSEC-TION-CIF SLY-LINE-&-ITS-EXT-ENT F, LOT TH N W ALONG THE EXTENIION OF SLY WI UNE TO POPPER 10527/6486

6 OAN R AFFECTED ADJACENT PROPERTY OWNER NOTARIZED STATEMENT OF C UNTY NO OBJECTION TO BOAT DOCK GOVERNMENT FLORIDA As required by Section of Orange County Code, the Environmental Protection Officer shall send notices by certified mail to the owners of the shoreline properties abutting the property on which the proposed boat dock is to be located. In cases where the nature of the shoreline is such that additional property owners will be affected, the environmental protection officer may send notices to those property owners as well. In the alternative, the applicant, at his option, may supply notarized letters of no objection from each of the affected adjacent property owners. The following is to be completed by the affected adjacent property owner as required by Section , Orange County Code. Ice GAL P ARC gi A- k ljeal, residing at Deer Isle Circle, (Affected Adjacent Property Owner Name) (Address) on Lake John's Lake (Name of Lake) boat dock cons uction plan d have no objection to the project., have reviewed my adjacent property owner's proposed (Signature) zot% (Date) (Print Name) ACKNOWLEDGEMENT: STATE OF FLORIDA COUNTY OF rkifine The foregoing instrument was acknowledged before me this 4 day of TV. Fes- I arch la pcp-1-4).(, by (NOTARY SEAL) t, "L (Signature of Nota ublic State of Florida) Personally Known OR Produced Identification / Type of Identification Produced Ronda D.7--/(ek's LAC, BD Adjacent Property Owner Rev

7 12' 11' 2'* 6' 24' 50 off \ / xl_ JOHN'S LAKE / 10' CABLE RAIL > I _ A stco 8' #-4' pe NHWE 91,51 158' t.-0--e-v, (2,00 r- u_ I-, I 7 5T7 c 7sIc C 1\-- c-

8 t,u-e, (rii a 61 b 2 s- T7 s(e C/ r. 12' MAX fijoi ABOVE DECK /.. JOHN'S LAKE 5' MAX

9 1" = 20' N 25' MIN SETBACK TURBIDITY BARRIER 1 OWEN SITE PLAN DETAIL DEER ISLE CIRCLE C N/7 e 1 10'! MINBETBACK Aro z td t.0 160'

10 DOC# : P: 2702 Preparedby andreturnto: 12/04/201311:41:10All Page 1 of 2 DianneHarris Rec Fee: $18.50 Deed Doc Tax: $ The ClosingAgent,Inc. DOR Admin Fee: $$.OO 11 N. Summerlin Ave. Ște.100 pn 1st. Orlando,FL artha0. Haynie, Comptroller Orange County, FL PU - Ret To: THE CLOSING AGENT INC FileNumber: (SpaceAboveThisLineForRecording Data) Warranty Deed This Warranty Deed made this20th day ofnovember, 2013,betweenSamuel GetzenWilsonand Barbara Jean Wilson,husband and wife, whose postofficeaddressis6144 Orange HillCourt,Orlando,FL 32818,grantors, Woodrow W. Owen Jr.and Nancy T. Krug, husband and wife,whose postofficeaddressis1439lake WhitneyDrive, Windermere,FL 34786,grantees: (Wheneverusedhereintheterms"grantor" and"grantee" include alltheparties tothisinstrument andtheheirs, legalrepresentatives, and assigns ofindividuals, andthesuccessors andassigns ofcorporations, trusts andtrustees) Witnesseth,thatsaidgrantor, forand inconsideration of thesum often AND NO/100 DOLLARS ($10.00)and other good and valuableconsiderations tosaidgrantorinhandpaidby saidgrantee, thereceiptwhereofisherebyacknowledged, has granted,bargained, and soldtothesaidgrantee, and grantee's heirsand assignsforeverțhefollowingdescribedland, situate, lyingandbeingintheorange County,Floridațo-wit: Lot 56,DEER ISLAND, accordingtotheplatthereofrecordedatplatbook 15,Pages63 through69, inclusive, ofthepublicrecordsoforange County,Florida. AND A portionofgovernment Lots5 & 6,Section31,Township 22 South,Range 27 East,Orange County, Florida,beingmore particularly describedasfollows: BeginattheSoutheastcornerofLot 56,"Deer Island",accordingtothePlatthereofasrecordedinPlatBook 15,Pages63 through69 ofthepublicrecordsoforange County,Florida;thencerun North 13 degrees04 minutes14 secondseast,alongtheeasterlylineofsaidlot 56 fora distanceof122.00fee tothenortheast cornerofsaidlot 56;thencerun South76 degrees13 minutes59 secondseast,alonga lineand itsextension ofthenortherlylineofsaidlot 56 toa pointon theordinaryhigh Water LineofJohn'sLake;thencerun SouthwesterlyalongtheOrdinaryHigh Water Linetoan intersection ofthesoutherlylineand itsextension ofsaidlot 56;thencerun North 74 degrees06 minutes12 secondswest,alongtheextensionofthesoutherly lineofsaidlot 56 tothepointofbeginning. ParcelIdentification Number: SUBJECT TO TAXES FOR THE YEAR 2013 AND SUBSEQUENT YEARS, RESTRICTIONS, RESERVATIONS, COVENANTS AND EASEMENTS OF RECORD, IF ANY. Together withallthe tenements, hereditaments andappurtenances theretobelongingorinanywiseappertaining. To Have and to Hold, thesame infeesimpleforever. And thegrantorherebycovenantswithsaidgranteethatthegrantorislawfullyseizedof saidlandinfeesimple;thatthe grantorhasgoodrightand lawfulauthority tosellandconveysaidland;tha thegrantorherebyfully warrantsthetitle tosaid landand willdefendthe same againsthe lawfulclaimsof allpersonswhomsoever;and thatsaidlandisfreeof all encumbrances, excepttaxesaccruingsubsequenttodecember31,2013. In Witness Whereof, grantorhashereuntosetgrantor's handandsealthedayandyearfirst abovewritten. Warranty Deed- Page 1

11 Signedșealedanddelivered inourpresence: WitnessNa F) 000 amuelgetze W 1son Witn N 10 (R 8 00 BarbaraJeanWil n Stateof Florida Countyof Orange The foregoinginstrument was acknowledgedbeforeme this20thday ofnovember,2013 by Samuel GetzenWilsonand BarbaraJean Wilson,who (_.)arepersonally known tome or( Licenseasidentification. aveproduceddriver's "P My CommissionExpires: DIANNEHARRIS Notary Public -StateofFlorida * My Comm.Expires May1,2017 Commission # FF Bonded Through National Notary Assn. Warranty Deed- Page 2

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