GOVERNMENT F L 0 R I I) A

APPLICATION TO CONSTRUCT A DOCK (In Accordance with Orange County Code Chapter 15, Article IX, Orange County Code) GOVERNMENT F L 0 R I I) A 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: Robert Renard Title and Company: Address: 8858 Great Cove Drive SECTION 1 City: Orlando State: Florida zip: 32819 Telephone and Fax: (407) 399-5663 Email: RRenardAdisr.com 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: Sheila Cichra Title and Company: Address: President, Streamline Permitting, Inc. 2154 Oak Beach Boulevard City: Sebring State: FL Zip: 33875 Telephone and Fax: (407) 450-4241 CONTRACTOR (IF DD. t ERENT FROM AGENT) Name: Title and Company: Address: Email: sheilacichra(a.qmail.com City: State: Zip: Telephone and Fax: Email: Dock Construction Application Revised 7/31113 Page I of 5

SECTION 2 - GENERAL INFORMATION Street Address: 10416 Pocket Lane Tax Parcel ID 09-24 - - 5844-00 - 582 Legal Description: WILLIS R MUNGERS LAND SUB E122 LOT 58 (LESS S 360 FT & N 200 FT & W 30 FT & E 60 FT THEREOF) Name of water body: Lake Pocket Canal Normal High Water Elevation (NHWE): 99.50 msl Is the proposed dock? Please check one: 40 Private Semi-Private Public What is the width of the shoreline (in linear feet), as measured at the NHWE? 100 feet. What is the size of proposed terminal platform? 504 square feet. [See Chapter 15; Article IX; Section 15-342(b)] Are you requesting a variance? Yes 1/ No Are you requesting a waiver? Yes 4/ No If yes, provide section Number: 15- (example: 15-3 21) and describe the nature of the variance and/or waiver request: Note applications for a waiver and/or variance from the how 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 an 18' x 28' boathouse with two 4' catwalks Are there docks on the abutting properties? Yes No Are there any access restrictions to the property (locked gate/loose dogs): NO REQUIRED ATTACHMENT(s) CHECKLIST: Satisfactory evidence of title. (E,Tg,p n copy of property deed). ca Documentation showing riparian rights for the parcel. a 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 follow ing: 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 7/31I 1 Page 245

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. Sheila Cichra Typed/Printed Name Signature Date President, Streamline Permitting, Inc. 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 Sheila Cichra Signature of Applicant/Agent Date President, Streamline Permitting, Inc. Corporate Title (if applicable) Dock Construction Application Revised 7/31113 Pagc 3 of 5

SECTION 3 Name and Address of adjacent property own ers. Name: Michael Stopperich Address: 10408 Pocket Lane City: Orlando State FL Zip 32836 Name: Michael Stopperich Address: 10408 Pocket Lane City: Orlando State FL Zip 32836 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. Dock Construction Application Revised 7131/13 Page 4 of 5

AGENT AUTHORIZATION FORM FOR PROJECTS LOCATED IN ORANGE COUNTY, FLORIDA (PRINT PROPERTY OWNER NAME) Robert Renard, AS THE OWNER(S) OF THE REAL PROPERTY DESCRIBED AS FOLLOWS, 10416 Pocket Lane DO HEREBY AUTHORIZE TO ACT AS MY/OUR AGENT (PRINT AGENT'S NAME), Sheila Cichra, TO EXECUTE ANY PETITIONS OR OTHER gnature of Pre" rty Owner ORA" E r ki GOVERNMENT F I ()KID DOCUMENTS NECESSARY TO AFFECT THE APPLICATION APPROVAL REQUESTED AND MORE SPECIFICALLY DESCRIBED AS FOLLOWS, boathouse 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: I ---R)bej+ QP101d Print Name Property Owner Date: Date: Date: STATE OF FLORIDA COUNTY OF ORANGE Signature of Property Owner Signature of Property Owner Signature of Property Owner Print Name Property Owner Print Name Property Owner Print Name Property Owner I certify that on,,t Lu iy-17.4)1(,, before me, C; vuel o (,, 4,( an officer duly authorized by the State of Florida and in the county mentioned above, to take a knowledgements, personally appeared Robert Renard, to me known to be the person described in this instrument or to have produced, as evidence, and who has acknowledged before me that he or she executed the instrument and did / did not take an oath. Witness my hand and official seal in the county and state stated above on the e, day of 31 in the year 201. z46....,,,,,, GREGORY CONNELL e S Notary Public - State of Florida )ires Mar 20, 2016 Commission # EE 156960 Signature of Notary Public Notary Public for the State of Florida My Commission Expires: Mctv\.(Aft t), Of Legal Description(s) or Parcel Identification Number(s) are required: PARCEL ID #: 09-24-28-5844-00-582 LEGAL DESCRIPTION: WILLIS R MUNGERS LAND SUB E/22 LOT 58 (LESS S 360 FT & N 200 FT & W 30 FT & E 60 FT THEREOF)

BOUNDARY SURVEY (PAGE 1 OF 2) PHOTOGRAPH VICINITY MAP (Not to scale) LEGAL DESCRIPTION: LOT 58, (LESS THE NORTH 200 FEET, LESS THE SOUTH 360 FEET, LESS THE EAST 60 FEET, LESS THE WEST 30 FEET) W.R. MUNGER LAND CO., ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK E, PAGE 22, IN SECTION 9, TOWNSHIP 24 SOUTH, RANGE 28 EAST, OF THE PUBLIC RECORDS OF ORANGE COUNTY, FLORIDA. ADDRESS: 10416 Pocket Lane Orlando, FL 32836 'JOB #901365 CF# 0C-E-22-LOT 58 FIELD DATE: 03-31-2015 SCALE: 1' = 40' DRAWN BY PJT REVISIONS ADD FORM BOARDS 12-28-15 RCJ Altamax Surveying 910 Belle Avenue, Suite 1140 Casselberry, FL 32708 Phone: 407-677-0200 Licensed Business No. 7833 www.alturnaxsunieying.corn Robert C. Johnson PSM 5551 CERTIFIED TO: ROBERT RENARD GENERAL SURVEY NOTES: 1. Bearing structure based on the monumented West line of Pocket Lane; being: assumed due South 2. This lot lies in Zone X, based on Flood Insurance Rate Map No. 12095C0395F, with an effective date of September 25, 2009, being in Un-incorporated Orange County, Florida. 3. This surveyor has not made a search of the public records for any dedications, limitations, restrictions or easements other than shown hereon. 4. Underground improvements have not been located. 5. This Survey has been made for the exclusive use of the entities certified to hereon and does not extend to any unnamed parties. 6. Not valid without the signature and the original raised seal of this Florida licensed Surveyor and Mapper, unless provided with electronic signature with ability to verify. The seal appearing on this document was authorized by Robert C Johnson on the Date of the electronic signature. 7. Elevations are based on Benchmark Designation S886010, being: 102.11 feet, (NAVD 88), published by Orange County Public Works Department. LEGEND AC - AR CONDMONER rt - CENTERLINE CBW - CONCRETE BLOCK WALL CC - COVERED CONCRETE CLF - CHAIN LINK FENCE CM - CONCRETE MONUMENT CO - CLEAN OUT CONC - CONCRETE COVD - COVERED CP - CONCRETE PAD CW - CONCRETE WALKWAY - CENTRAL ANGLE D&M - DESCRIBED & MEASURED DE - DRAINAGE EASEMENT DESC - DESCRIPTION JO\ - DOT MANHOLE DW - DRIVEWAY EB - ELECTRICAL BOX E/P - EDGE OF PAVEMENT - ELECTRIC METER ESMT - EASEMENT FFE - FINISHED FLOOR ELEVATION FH - FIRE HYDRANT FND - FOUND >- - GUY WIRE ANCHOR IP - IRON PIPE R - IRON ROD L - ARC LENGTH ViC - LIGHT POLE LSA - LANDSCAPE AREA MEAS - MEASURED MF - METAL FENCE N&D - NAIL & DISK OW - OVERHEAD WIRE ORB - OFFICIAL RECORDS BOOK P&M - PLAT & MEASURED P8 - PLAT BOOK PC - POINT OF CURVATURE PG - PAGE POB - POINT OF BEGINNING POC - POINT OF COMMENCEMENT R - RADIUS R/W - RIGHT OF WAY TB - TOP OF BANK - TRANSFORMER T TV - CABLE TV RISER TYP - TYPICAL UE - ummy EASEMENT UP - UTILITY POLE _0_ - WATER METER sr - WATER VALVE WF - WOOD FENCE WS - WOOD SHED # - NUMBER