ORAN 1E UNTY GOVERN1'IENT F 10121D APPLICATION TO CONSTRUCT A DOCK

ORAN 1E UNTY GOVERN1'IENT F 10121D 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 32808 (407) 836-1400, Fax (407) 836-1499 **Filing fee of $119.00 payable to The Board of County Commissioners** **Process fee for Appeals and Variances: $409.00** OWNER(S) OF THE LAND Name: Title and Company: Address: Douglas Childs 4282 Caledonia Avenue SECTION 1 City: Apopka State: Florida Zip: 32712 Telephone and Fax: (407) 766-0008 Email: dchildsaorlandofoot.com ENTITY TO RECEIVE PERMIT (W OTHER THAN OWNER) Name: N/A Title and Company: Address: City: State: Zip: Telephone and Fax: Email: AGENT/CONSULTANT AUTHORIZED TO SECURE PERMIT Name: Sheila Cichra Title and Company: Address: Streamline Permitting, Inc. 2154 Oak Beach Blvd City: Sebring state: FL Zip: 33875 Telephone and Fax: (407) 450-4241 Email: sheilacichra gmail.com CONTRACTOR (IF DIFFERENT FROM AGENT) Name: Ron Tegeler Title and Company: President, Creative Deck and Dock, Inc_ Address: P 0 Roy 852 City: Windermere State: FI zip: 34786 Telephone and Fax: (407) 876-0005 Email: ronteg@earthlink.net Dock Construction Application Revised 7/31/13 Page 1 of 5

SECTION 2 - GENERAL INFORMATION Street Address: 7721 Summerlake Pointe Blvd. Tax Parcel ID 28-23 - 27-0566 - 19-060 Legal Description: Lot 6, Block S, Summerlake PD, Phase 1B A Replat per Plat Book 78, Page 42 Name of water body: Lake Hancock Normal High Water Elevation (NHWE): 97.30 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? 78.13 feet. What is the size of proposed terminal platform? 492 square feet. [See Chapter 15; Article DC; Section 15-342(b)1 Are you requesting a variance? Yes Ae No Are you requesting a waiver? Yes A/No If yes, provide section Number: 15- (example: 15-321) 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: Construct a 4' x 36' boardwalk/dock and a 16' x 27' boathouse and install a 5' x 12' jetski port. Are there docks on the abutting properties? Yes V Are there any access restrictions to the property (locked gate/loose dogs): No REQUIRED ATTACHMENT(s) CHECKLIST: Satisfactory evidence of title. (Example: copy of property deed). Cif 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. Dock Construction Application Revised 7/31/13 Page 2 of 5

The NHWE 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 (if applicable) 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 1 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. Sheila Cichra Typed/Printed Name President, Streamline Permitting, Inc. Corporate Title (if applicable) Signature Date 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. 1 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 15-341 & 15-342, Orange County Code. Typed/Printed Name of Applicant Sheila Cichra Signature of Applicant/Agent Date /240/,. President, Streamline Permitting, Inc. Corporate Title (if applicable) Dock Construction Application Revised 7/31/13 Page 3 of :3

SECTION 3 Name and Address of adjacent property owners: Name: Michael Shaul Address: 7727 Summerlake Pointe Blvd City: Winter Garden State FL Zip 34787 Name: David Farlow Address: 7715 Summerlake Pointe Blvd City: Winter Garden State FL Zip 34787 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 decd restrictions and/or consult with your Homeowner's Association or Architectural Review Board. Dock Construction Application Revised 7/31/13 Page 4 of 5

AGENT AUTHORIZATION FORM FOR PROJECTS LOCATED IN ORANGE COUNTY, FLORIDA ua GOVERNMENT L 0 R I 1) A /WE, (PRINT PROPERTY OWNER NAME) Douglas Childs, AS THE OWNER(S) OF THE REAL PROPERTY DESCRIBED AS FOLLOWS, 7721 Summerlake Pointe Blvd., Winter Garden, 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, Boat 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. Date: (0 bo kit Vii.- -S M g./a.0w # Print Name Property Owner Date: Date: Signature of Property Owner Signature of Property Owner Print Name Property Owner Print Name Property Owner Date: STATE OF FLORIDA COUNTY OF ORANGE I certify that on 1-uf)e a D, ac I s-, Signature of Property Owner Print Name Property Owner before me, 0 1 \CA.\ an officer duly authorized by the tate of Florida and in the county mentioned above, to take acknowledgements, personally appeared, to me known to be the person described in this instrument or to have produced ( l e_ 5 r., as evidence, and who has acknowledged before me that he or she executed the instrument an did did not take an oath. Witt my hand and official seal in the county and state stated above on the day of )1A-T1 E. in the year. sari L E SANKEY.0": MY COMMISSION # FF204515. EXPIRES February 26. 2019 3484.4" 53 rk,dallotarysennce coif Signature of Notary Public Notary Public for the State of Florida My Commission Expires: 19R.U-0.-2y 02(o 9r Legal Description(s) or Parcel Identification Number(s) are required: PARCEL ID #: 28-23-27-0566-19-060 LEGAL DESCRIPTION: LOT 6, BLOCK S SUMMERLAKE PD PHASE 1B - A REPLAT 78/42

THIS INSTRUMENT PREPARED BY RECORD AND RETURN TO: 01 730 P: 7407 BestAmericanTitle, LLC Rec Fee: 10.00 age 1 of 1 AlexCvercko $ 4.00 13500SuttonParkDriveS. IntangibleTax: 0.00 Suite304 r tgage Stamp; e ye Jacksonville, FL 32224 Orange u" ni Comptroller EX - Ret To ALEXANDERB CVERCKO ESQUI RE PARCEL ID #:28-23-27-0566-19-060 CONTRACT SALES PRICE:$211,000.00 WARRANTY DEED THIS WARRANTY DEED made this8th day of April, 2014 by BDWB Summerlake, LLC, a Florida limited liabilitycompany, hereinaftereferredto as Grantor,whether one or more, and whose address is P.O. Box 770399, Winter Garden, FL 34777, to Douglas Matthew Childs and Andria Childs, husband and wife,hereinaftereferredto as Grantee, whether one or more, and whose addressis4282 CaledoniaAve, Apopka 32712. (Wherever usedherein theterm"grantor" and"grantee" include alltheparties tothis instrument andtheheirs, legal representatives andassigns ofindividuals, andthesuccessors andassigns ofcorporations.) WITNESSETH: THAT Grantor,forand inconsiderationof thesum of Ten and NO/100 Dollarsand other valuableconsiderations, in hand paid by Grantee, the receipt whereof is hereby acknowledged, hereby grants,bargains șells,aliens,remises,releases,conveys and confirmsunto Grantee the followingdescribedland situate,lying and being in the County of Orange, Stateof Florida to wit: Lot 6, Block S of BLOCK S, SUMMERLAKE PD PHASE 1B-A REPLAT, according to the Platthereofas recorded in PlatBook 78,Pages 42 and 43,of the Public Records of Orange County, Florida. SUBJECT TO taxes accruingsubsequent todecember 31,2013. SUBJECT TO covenants,restrictions and easements of record,ifany; however, this referenceshallnot operate to reimpose same. TO HAVE AND TO HOLD thesame infee simple forever. AND Grantor hereby covenantswith Grantee thatgrantorislawfullyseizedof saidland in fee simple; thatgrantorhas good right and lawful authority to selland convey saidland;that Grantor hereby fully warrantsthe titleto saidland and willdefend the same against the lawful claimsof all personswhomsoever; and thatsaidlandisfreeof allencumbrances. IN WITNESS WHEREOF, Grantor has signed and sealedthese presents the day and yearfirstabove written. Signed,sealedand deliveredinour presence: BDWB Summerlake,LLC, aflorida limited liability company By:CameronBradford Its:Authorized Signatory STATE COUNTY OF Florida OF Orange The foregoing instrumentwas acknowledged beforeme this8th day of April, 2014 by Cameron Bradford, Authorized Signatory for BDWB Summerlake, LLC, a Floridalimited liability company, on behalf of the company. He has produced I \ 4 we 4 1...8' as identifica tary Pu liccoun andstate Alaresaid ) 04 Notary Printed Signature My commission expires; / 2 21) / CARLOS F FERNANDEZ *C-MY COMMISSION# EE873802 o us EXPIRESFebruary 12.2017 w - Documentary Stamps intheamount of $1,477.00have been paid. Page1of1 Formsoftware by:automated RealEstate Services, Inc. -800.330.1295 File: 14-0008

CHILDS BOATHOUSE PLAN --raxv cl ("Arrt.e. S. 27.00` 7e +.5 ; eori- 11' 4.00'; COVERED BOAT SLIP _ NHVVE 411.3 NHWE C1. 3 0 36.00" PICKETED RAIL DOM BOTH SIDES AS PER CODE 4 4.00' > ro 1 A (vit. W 6-mv-ccei, scale 1/8" = 1

/ / PICKETED RAILING OVER CONSERVATION AREA TO NHWE 1 6'8' MIN 1 1 1 1 1 1 3' MIN CONSERVATION AREA 2' MIN LAKE HANCOCK =11 74. 97.3 'MAX 12' MAX CHILDS SIDE ELEVATION - 7721 SUMMERLAKE POINTE BLVD - WINTER GARDEN, FL

SITE PLAN \\ \ \\ X \ \ A \ DESCRIPTION: LOT 6, BLOCK S, SUMMERLAKE PD PHASE 1B A REPLAT, ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 78, PAGES 42 AND 43, PUBLIC RECORDS OF ORANGE COUNTY, FLORIDA, \ V) \ o\ \ o \.,- _a\ cel \ \ TYPE -82" LOT GRADING DRAINAGE FLOW 108.39 PROPOSED GRADE v Por-e6 0 LEGEND: =FOUND 1/2" IRON ROD NO#,0 =FOUND 4")(4" CONCRETE MONUMENT LB 6723 C1 LENGTH 98.86' RADIUS 602.00' DELTA 09'24'34" 0 9G 1_, As 05: VW\-- c:,0\r4 PRO C2 LENGTH 5.95' RADIUS 602.00' DELTA 00'33'58" SURVEYOR'S NOTES: CERTIHCATHON TO: SBest American Title, LLC First American Title Insurance Company Bella Building Group, LLC BDWB Summerlake, LLC SLV Summerlake, LLC Douglas and Andria Childs 1. THE SURVEYOR DID NOT PERFORM AN ABSTRACT OF TITLE, THE ABOVE REFERENCED PROPERTY MAY BE SUBJECT TO ADDITIONAL EASEMENTS, RIGHTS OF WAY AND RESTRICTIONS OF RECORD, IF ANY 2. LEGAL PROVIDED BY CuENT. 3. BEARING SHOWN HEREON ARE BASED ON THE W une OF SUMMERLAKE PD PH IB AS BEING NO6'33'37"W PER PLAT. 4. REPRODUCTIONS OF THIS SKETCH ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. DATE, 4/ /14 Dote I SCALE, 1 = ao' I CAL. BY: SEB I DRAWN BY: SEB JOB NO. 114029 Revisions ATLANTIC SURVEYING 308 S. DILLARD STREET WINTER GARDEN, FLORIDA 34787 (407) 656-4993/FAX (407) 656-4437 STEVEN E. BLANKENSHIP P.S.M #5361 STATE OF FLORIDA