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
Lori HodgskinPresident, Hodgskin Outdoor Living, Inc.
1331 Green Forest Court, Suite 1
Winter Garden FL 34787
(407) 656-1470 [email protected]
FloridaOrlando
Dipenkumar Patel
9730 Chestnut Ridge Drive
34786
Page 2 of 5 Dock Construction Application Revised 7/31/13
SECTION 2 - GENERAL INFORMATION
Street Address: _________________________________________________________________________________ ____
Tax Parcel ID _____ - _____ - _____ - _______ - _____ - _____ Legal Description: ___________________________________________________________________________________
Name of water body: __________________ Normal High Water Elevation (NHWE): ____________msl
Is the proposed dock? Please check one: � Private � Semi-Private � Public
What is the width of the shoreline (in linear feet), as measured at the NHWE? ___________feet.
What is the size of proposed terminal platform? _____________ square feet. [See Chapter 15; Article IX; Section 15-342(b)]
Are you requesting a variance? � Yes � No
Are you requesting a waiver? � Yes � 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: _________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Are there docks on the abutting properties? � Yes � No
Are there any access restrictions to the property (locked gate/loose dogs):_________________________________________
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.
x
x
x
x
23 28 0016
9730 Chestnut Ridge Drive
3899 140
ISLEWORTH 16/118 LOT 14
Lake Bessie 97.50
196
134
Redeck existing dock and replace existing terminal platform with a 14' x 14' covered deck
gated subdivision
Page 3 of 5 Dock Construction Application Revised 7/31/13
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 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.
_____________________________________________________________________________________________
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 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:
Name:
Address:___________________________________________________________________________________________
City: State Zip ______________________
Name: _____________________________________________________________________________________
Address: ___________________________________________________________________________________
City: State 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.
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 •
P.O. Box 843 • Ocoee, Florida 34761 Phone - (407) 656-1470 • Fax: (407) 656-1452 • www.hodgskin.com
JOB BcTEL. RESIDENCE
SHEET NO OF
ADDRESS 9130 CHas-r-NoT RviDGE DRIVE
SCALE
LAKE BESSIE
NHWE 97.50
wl-DE MAIN WA:.,'<-
(NTS)
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
6'8" MIN
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Panel - 0385 F
Date: 9/25/2009
Old Republic National Title Insurance Company
F boo Zone: x 6 AE
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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