SHORELINE ALTERATION/DREDGE AND FILL PERMIT APPLICATION

Transcription

1 ORAN E C IUNT GOVERNMENT F I. 0 It I I) SHORELINE ALTERATION/DREDGE AND FILL PERMIT APPLICATION (In Accrdance with Orange Cunty Cde, Chapter 15. Article VI, and Chapter 33, Articles II and IV) Mail r Deliver T: Orange Cunty Envirnmental Prtectin Divisin 800 Mercy Drive Orland, Fl (407) , Fax (407) **Enclse a check fr the filing and advertising fee f $ payable t The Bard f Cunty Cmmissiners** **Prcess Fee fr Appeals and Variances - $409.00** OWNER(S) OF THE LAND Name: Title and Cmpany: Address: Bridge Huse Rd Nancy Adams City: Windermere State: FL Zip: Telephne and Fax: ENTITY TO RECEIVE PERMIT (IF OTHER THAN OWNER) Name: Title and Cmpany: Address: City: State: Zip: Telephne and Fax: AGENT/CONSULTANT AUTHORIZED TO SECURE PERMIT Name: Sheila Cichra fr Peter Fleck Title and Cmpany: Address: FMC, Inc Wnder Lane City: Windermere State: FL Zip: Telephne and Fax: (407) PKFleck@al.cm CONTRACTOR (IF DIFFERENT FROM AGENT) Name: Title and Cmpany: Address: City: State: Zip: Telephne and Fax: Applicatin fr Shreline Alteratin-Dredge & Fill Rev 7-31-I3.dcx Page 1 f 4

2 SECTION 2 - GENERAL INFORMATION: LOCATION OF PROPERTY Street Address: 9106 Bay Pint Drive, Windermere, FL Tax Parcel ID (s) LEGAL DESCRIPTION Lt 16, BAY POINT as per Plat Bk 7, page 49 Name f water bdy: Tibet Butler Nrmal High Water Elevatin (NTIWE): 99.5 msl Descriptin f Wrk (This shuld include mitigatin, including re-vegetatin): Ad:01 vt 61-e e gf If GI d t, LA,' 1 a L-AT \ cs P t P -e // rap,s 4'3 rte, Justificatin fr the alteratin: T cntrl ersin frm wave actin. REQUIRED ATTACHMENT(S): Three (3) cpies f the Shreline Alteratin Plans that include the fllwing: (A Prfessinal Engineer must prepare and sign the plans) The current and Nrmal High Water Elevatins (NHWE). Lake Name. A nrth arrw. Bttm elevatins r water depths. The dimensins f the prperty (including ttal linear feet f shreline at the NHWE). Existing structures and prpsed alteratin areas with dimensins in feet r square feet. The lcatin f the requested wrk with respect t the upland wner's prperty and adjacent prperties. The wner's name and site address must be n each page f the plans. A descriptin f sedimentatin and ersin cntrl measures used during cnstructin. A prperty survey r have the alteratin areas drawn t scale n a survey. A descriptin f vegetatin types identified prpsed fr alteratin. Cmplete mailing address f all prperty wners within 500 feet f the prject s that Orange Cunty may ntify them f the Public Hearing. As f January 1, 2009, the attached disclsure frms are required with all permit applicatin submittals. The frms listed belw must be cmpleted and ntarized. AGENT AUTHORIZATION FORM Click here t submit RELATIONSHIP DISCLOSURE FORM-DEVELOPMENT RELATED SPECIFIC EXPENDITURE REPORT FORM Click here t submit Click here t submit Applicatin fr Shreline Alteratin-Dredge & Fill Rev dcx Page 2 f 4

3 PERSON AUTHORIZING ACCESS TO THE PROPERTY MUST COMPLETE THE FOLLOWING: I either wn the prperty described in this applicatin r I have legal authrity t allw access t the prperty and I cnsent t any site visit n the prperty by agents r persnnel frm Orange Cunty, Flrida necessary fr the review and inspectin f the prpsed prject specified in this applicatin. I authrize these agents r persnnel t enter the prperty as many times as may be necessary t make such review and inspectin. Further, I agree t prvide entry t the prject site fr such agents r persnnel t mnitr permitted wrk if a permit is granted. Nancy Adams ita t ---,, Typed/Printed Name Signature Date Crprate Title (if applicable) By signing and submitting this applicatin frm, I am applying fr the permit identified abve, accrding t the supprting data and ther incidental infrmatin filed with this applicatin. I am familiar with the infrmatin cntained in this applicatin, and represent that such infrmatin is true, cmplete, and accurate. I understand this is an applicatin and nt a permit, and that wrk cnducted prir t apprval is a vilatin. I understand that this applicatin and any permit issued pursuant theret, des nt relieve me f any bligatin fr btaining any ther required federal, state, water management district r lcal permit prir t cmmencement f cnstructin. I agree, r I agree n behalf f my crpratin, t perate and maintain the permitted system unless the permitting agency authrizes transfer f the permit t a respnsible peratin entity; I understand that knwingly making any false statements r representatin in this applicatin is a vilatin f Sectin , Orange Cunty Cde. Sheila Cichra Typed/Printed Name f Applicant ;( Signature f Applicant/Agent FMC, Inc. Date Crprate Title (if applicable) Applicatin fr Shreline Alteratin-Dredge & Fill Rev dcx Page 3 f 4

4 AGENT AUTHORIZATION FORM FOR PROJECTS LOCATED IN ORANGE COUNTY, FLORIDA CfTiY GOVERNMENT,,,, k I I) /WE, (PRINT PROPERTY OWNER NAME) Nancy Adams, AS THE OWNER(S) OF THE REAL PROPERTY DESCRIBED AS FOLLOWS, 9106 Bay Pint Drive, DO HEREBY AUTHORIZE TO ACT AS MY/OUR AGENT (PRINT AGENT'S NAME), Sheila Cichra, TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE APPLICATION APPROVAL REQUESTED AND MORE SPECIFICALLY DESCRIBED AS FOLLOWS, seawall 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 APPLICATION. Date: 15 I Zi14 Signature lf-lirperty Owner Nancy Adams Print Name Prperty Owner Date: Signature f Prperty Owner Print Name Prperty Owner STATE OF FLORIDA COUNTY OF ORANGE I certify that the freging instrument was acknwledged befre me this day f by Nancy Adams Mis/she is persnally knwn t me r has prdduced cl as identificatin and did/did nt take an ath. Witness my hand and fficial seal in the cunty and tate stated ve n the, in the year 2015 day f JIMARA DE JESUS Ntary Public - State f Flrida "# sy, 4igq i.fxpires May 11, 2018 c" YCYrtrelSiSi011 # FF " '''''''''' Bnded Thrugh Natinal Ntary Assn. Nta Public blic fr he State f Flrida My Cmmissin Expires: J 1 [III Legal Descriptin(s) r Parcel Identificatin Number(s) are required: PARCEL ID #: LEGAL DESCRIPTION: Lt 16, BAY POINT as per Plat Bk 7, page 49

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