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** SECTION 1 OWNER(S) OF THE LAND Name: ____________________________________________________________________________________________________ Title and Company: ___________________________________________________________________________________________ Address: ____________________________________________________________________________________________________ City: ______________________________ State: ______________________ Zip: _________________ Telephone and Fax: ___________________________________Email:___________________________________________________ ENTITY TO RECEIVE PERMIT (IF OTHER THAN OWNER) Name: ____________________________________________________________________________________________________ Title and Company: ___________________________________________________________________________________________ Address: ____________________________________________________________________________________________________ City: ___________________________________________________________________________State: _______ Zip: ___________ Telephone and Fax: ____________________________________Email:__________________________________________________ AGENT/CONSULTANT AUTHORIZED TO SECURE PERMIT Name: ____________________________________________________________________________________________________ Title and Company: ___________________________________________________________________________________________ Address: ____________________________________________________________________________________________________ City: ___________________________________________________________________________State: _______ Zip: ___________ Telephone and Fax: ____________________________________Email:_________________________________________________ CONTRACTOR (IF DIFFERENT FROM AGENT) Name: ____________________________________________________________________________________________________ Title and Company: ___________________________________________________________________________________________ Address: ____________________________________________________________________________________________________ City: ___________________________________________________________________________State: _______ Zip: ___________ Telephone and Fax: ____________________________________Email:__________________________________________________ Page 1 of 5 Dock Construction Application Revised 7/31/13 (407) 450-4241 FL President, Streamline Permitting, Inc. 2154 Oak Beach Boulevard Sebring 33875 Sheila Cichra [email protected]Lori Hodgskin President, Hodgskin Outdoor Living, Inc. 1331 Green Forest Court, Suite 1 Winter Garden FL 34787 (407) 656-1470 [email protected]Florida Orlando Dipenkumar Patel 9730 Chestnut Ridge Drive 34786
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APPLICATION TO CONSTRUCT A DOCK - Orange … Construction Application Revised 7/31/13 (407) 450-4241 FL President, Streamline Permitting, Inc. 2154 Oak Beach Boulevard Sebring 33875
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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**
SECTION 1
OWNER(S) OF THE LAND Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
Telephone and Fax: ___________________________________Email:___________________________________________________
ENTITY TO RECEIVE PERMIT (IF OTHER THAN OWNER) Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
Telephone and Fax: ____________________________________Email:_________________________________________________ CONTRACTOR (IF DIFFERENT FROM AGENT) Name: ____________________________________________________________________________________________________
Title and Company: ___________________________________________________________________________________________
______________________________________________________________________________________________________ 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: _________________________________________________________________________
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.
____________________________________________________________ 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 15-341 & 15-342, Orange County Code.
Typed/Printed Name of Applicant _______________________________________________________
Signature of Applicant/Agent _____________________________________Date__________________
_________________________________________
Corporate Title (if applicable)
Sheila Cichra
President, Streamline Permitting, Inc.
President, Streamline Permitting, Inc.
Sheila Cichra 12/08/2015
12/08/2015
Page 4 of 5 Dock Construction Application Revised 7/31/13
SECTION 3 Name and Address of adjacent property owners:
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.
FL
Stuart Appleby
Cleveland OH 44114
Dennis Ginsburg
1500 San Remo Ave, Ste 125
Coral Gables 33146
1360 E 9th Street, Ste 1100
HODGSKIN Outdoor Living, Inc. • Florida's Finest Custom Built •
Drawings and illustrations contained herein are the property of Hodgskin Outdoor Living, Inc. and shall not be copied, reproduced, duplicated, misused or misrepresented in any part or entirety, or made available for bidding purposes, without the expressed written consent of Hodgskin Outdoor Living, Inc. Misuse of these documents may result in a civil penalty.
License# CBC 057656 Florida Marine Contractors Association Founding Member www.hodgskin.com
12' MAX ABOVE DECK
041111■10 PATEL ELEVATION 9730 CHESTNUT RIDGE DR. WINDERMERE, FL
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Date: 9/25/2009
Old Republic National Title Insurance Company
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Community Number 12095C
CERTIFIED TO: Windermere Chestnut, Inc. J. Black Title Company
PATEL SITE PLAN 9730 CHESTNUT RIDGE DRIVE WINDERMERE, FL 34786
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Boundary Survey Legal Description: Lot 14, ISLEWORTH, according to the Plat thereof as recorded in Plat Book 16, Page(s) 118-130, Public Records of Orange County. Florida.