C unly GOVERNMENT FLORIDA APPLICATION TO CONSTRUCT A DOCK. (In Accordance with Orange County Code Chapter 15, Article IX, Orange County Code)

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1 C unly GOVERNMENT FLORIDA 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** SECTION 1 OWNER(S) OF THE LAND Name: Ben Alilin!lei^ 11/,'((k, Title and Company: Owner Address: 8616 Captiva Court City: Orlando State: Florida Zip: Telephone and Fax: dralilin@hotmail.com ENTITY TO RECEIVE PERMIT (IF OTHER THAN OWNER) Name: 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: sheilacichra@gmail.com CONTRACTOR (IF DIFFERENT FROM AGENT) Name: Lon Hodgskin Title and Company: President, Hodgskin Outdoor Living, Inc. Address: F0 Box 843 City: Ocoee State: Telephone and Fax: / lori@hodgskin.com FL Zip: Revised Page 1 of 5

2 SECTION 2 - GENERAL INFORMATION Street Address: 8616 Captive Court Tax Parcel ID 12 _ 22 _ 30 _ 3546 _ 00 _ 140 Legal Description: Hidden Cove Estates 10/12 Lot 14 Name of water body: ire Zrw cv, SS-~ Normal High Water Elevation (NHWE): msl Is the proposed dock? Please check one: PrivateDSemi-Private TiPublic What is the width of the shoreline (in linear feet), as measured at the NHWE? 5 feet. What is the size of proposed terminal platform? _6 3 7 square feet. [See Chapter 15; Article IX; Section (b)] Are you requesting a variance? EiYes Are you requesting a waiver? Yes EiNo If yes, provide section Number: 15-3 ci 3 6 (example: ) and describe the nature of the variance and/or waiver request: '49 k c 7i"; otgej cck, tiz, 131 e -f-ee In e ac CO vtad 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: C tlf0 / )( ek tc-tv 0 u s.e o Cly ti/ 2 y 1)4. '1 tty-1 t..,5 LA (t'a.-s-^ 14- cl 2o' r ek Are there docks on the abutting properties? Are there any access restrictions to the property (locked gate/loose dogs): Ai /14 REQUIRED ATTACHMENT(S) CHECKLIST: Satisfactory evidence of title. (Example: copy of property deed). Documentation showing riparian rights for the parcel. A copy of a survey, to scale, of the real property which accurately depicts current conditions. 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. Revised Page 2 of 5

3 The NHWE as established by the county and 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 (if applicable). A description of sedimentation and erosion control measures used during construction and/or repair of the dock. 1:1 Depict and label the projected property lines (if applicable, ie not SSL). 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 be 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. Ben Alilin Erm atifi - /_r 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; I 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 W 2 President, Streamline Permitting, Inc. Corporate Title (if applicable) Revised Page 3 of 5

4 SECTION 3 Name and Address of adjacent property owners: Name: 6 Cm. irt iru 4-71'147v- el fivt) c,4 7cy Address: 2(9 27 A4,4 ("6-vt' a. C City: 0 r cqa State Zip Fl 7 Name: 1:6,1/ (4/t /7 t lea v. G IC a "14, ey J. 's /Idle Address: -2Y (...}Ace 61-77e-6- k e City: C-6 lectitk State Zip V.3 `2 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. Revised Page 4 of 5

5 AGENT AUTHORIZATION FORM FOR PROJECTS LOCATED IN ORANGE COUNTY, FLORIDA UWE, (PRINT PROPERTY OWNER NAME) Ben Alilin, AS ORAN - E C/' IUNTI GOVERNMENT FLOR I THE OWNER(S) OF THE REAL PROPERTY DESCRIBED AS FOLLOWS, 8616 Captiva court, 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, Dock 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. DA Date:147-A Ben Alilin Sig f Property Owner Print Name Property Owner Date: Signature of Property Owner Print Name Property Owner STATE OF FLORIDA COUNTY OF Orange I certify that the foregoing instrument was acknowledged before me this/ 20 by iezigahit-di. ness my hand an in the year day of He/sheis_per-sorrally known---- to me or hi3s produced as identification and did/did not take an oath. official seal in the county and state stated above on the / 7 day of 14/ VaY 1344te Notary Public State of Florida,1 4r,faAvip 8gwpan-Blevins -;.1.44 'VT Ubm m sn'n EE Expires 05/15/2015 ignature of otary Public Notary Public for the State of Florida My Commission Expires: 5/ 15/15 Legal Description(s) or Parcel Identification Number(s) are required: PARCEL ID #: LEGAL DESCRIPTION: Hidden Cove Estates 10/12 Lot 14

6 This Warranty,Deed ' Made this day of, 20 y DOC# B: P: 5870 Lewis C. Jones AN Wanda P. Eppes, individually 95/18/ :07:35API Page 1 of 1 and as Trustee of Tuscarora Revocable Ree LivingTrust Fee: 1e.ee ee dated July 29,2005 (asto Parcel1)and From Wanda p. n lea xtade Eppes and lewisc. Jones (As to Parcel2) 11ortgagestamp: $e.ee 11artha0. Haynze, Comptroller Orange County FL 11B- Ret To: AUNBELT TITLE AGENCY hereinafter calledthegrantorțo a, Ben D. Alilinand Louanna A. Alilin, Wife And Husband whose postofficeaddress is: 8616 Captiva court Orlando, FL hereinafter calledthegrantee: (Wheneverusedhereintheterm"grantor" and"grantee" include alltheparties tothisinstrument andtheheirs, legalrepresentatives and assignsofindividuals, andthesuccessors andassignsofcorporations) Witnesseth, thathegrantor, forandinconsideration ofthesum of$10.00andothervaluable considerations, receipt whereofis herebyacknowledged, herebygrants, bargains, sells, aliens, remises, releases, conveysandconfirms untothegrantee, allthatcertain land situate inorangecounty,florida, viz: Lot 14, HIDDEN COVE ESTATES, according to the platthereofas recorded in PlatBook 10, Page 12 of the PublicRecords of Orange County, Florida. PARCEL 2: A portion of Lot 13,HIDDEN COVE ESTATES according to the platthereofas recorded in PlatBook 10 at Page 12 of Public Records of Orange County, Florida,being more particularlydescribed as follows;begin at the S.E.corner of Lot 12 of said HIDDEN COVE ESTATES; thence run South 3*06'43"West along the West lineof said Lot 13,21.27feet;thence run South 89*15'46"eastfor20.53feet;thence run South 47*22'53"East for1.32 feetto the Easterly lineof said Lot 13,thence run North 1*00'10"West along the Easterlylineof said Lot 13 for 92.86feetto the most Northerlylineof said Lot 13;thence run Northwesterlyalong said Northerlyline,being a circularcurve concave to the Northeast and having for itselements a radius of feet,a centralangle of 15*54'22",a chord of feetand a chord bearing of N. 74*28'10"West for an arc distanceof 15.27feetto the West lineof said Lot 13;thence run South 3*06'43"West for74.63feetto the Pointof Beginning. Subjectocovenants,restrictions, easementsofrecordand taxesforthecurrentyear. ParcelIdentification Number: Togetherwithallthetenements, hereditaments andappurtenances thereto belonging orinanywiseappertaining. To HaveandtoHold țhesame infeesimpleforever. And thegrantor herebycovenantswithsaidgranteethathegrantor islawfully seizedofsaidlandinfeesimple; thathegrantorhas goodright andlawful authority tosellandconveysaidland;thathegrantor herebyfully warrantsthetitle tosaidlandandwilldefendthe same against thelawful claimsofallpersonswhomsoever;andthatsaidlandisfreeofallencumbrancesexceptaxesaccruing subsequent todecember31,2009 InWitnessWhereof țhesaidgrantor hassignedandsealedthesepresents thedayandyearfirst abovewritten. Signed, sealed and delivere inour presence: LewisC. Jones and Wanda P. Eppes, individually Witne. (Signatur and as TrusteesoftheTuscaroraRevocable PrintName: <Ec;A{ E r 5 LivingTrust,datedJuly29,2005 (as toparcel1) frornwanda P. Eppes and Lewis C. Jones Witness: (Signature) PrintName: wicia ft 4, ( ' C. Jon dividually and as Trustee Wanda P. Eppes, in allyand as Trustee Stateof O)O fa Cl0 County of ~ft //er 4 Theforegoing instrument wasacknowledged beforeme this day of OL(. 20LO,byLewisC.Jones,individually andastrusteeandwanda P.Eppes,individually andastrustee, who ispersonally kngwntome orwho hasproducedphotoidas idenification. NOTARY PU (si nature PrintName: 1 1/) a. &6? C, My Co sley'e pires: / - / / -,10 / Sta Seal RETURN TO: Prep ed by- Sunbeft Title Agency 2"iseltT 809 South Orlando nd Avenue Laj Suites K-0 spean *137 Winter Park, Florida32789 Incidept totheissuanceofa title insurance contract. WARRANTYDEED.dot REV.11/05/09 AC

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