1751 ATLANTIC BEACH DR DRIVEWAY R.O.W. Permit Attachment of for 1-1 155 1 Al(ail-1 C &OL
R.O.W. Permit# issued , 200_ Atlantic Beach, FL 32233
Owner's Name: �l V QX Sl C'(Q -Y Da Q S
Property Address: —7 151 (U"-KC_ ,QCX_e_k r,
c 3a a?3
Subdivision: I Q.,N�C t2k( -C,� CovN1�� C°(�l�
Lot#/Block#: Loi- 33
R.E.
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
, 200_, by Atlantic Beach, Florida, a municipal corporation organized and existing
under the laws of the State of Florida, hereinafter referred to as "CITY" and RiVQxSlCk-_> A-4( mQs
of Atlantic Beach, Florida, hereinafter referred to as "USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the
right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Easement permit numbers noted above (copies attached).
This work is generally described as: NOW CSV,5trLkQA1C*-� — S1=IQ
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted
remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to
USER shall be given by certified mail, return receipt requested, to the following address:
1 a Q:]LQ err Josue ' w(A ai;-fie 1a0, J(Xk6C •,V i I le,moi - 303D3
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
In the event it is necessary for the CITY or the City's approved representative or other franchised
utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's
sole expense, any and all material necessarily displaced during the action of maintaining, repairing,
operating, replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Building
Codes, Land Development Code, and all other land use and code requirements of the CITY, including
City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be
replaced with other materials, but must be replaced with smooth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
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The USER, prior to making any changes from the approved plans and/or method, must obtain
written approval from the City of Atlantic Beach, Public Works Department, for said change. The
USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change
within thirty (30) days after the day of completion.
This permit shall insure to the benefit of, and be binding upon, the USER and their respective
successors and assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY
laws and/or specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of-way and other public land. USER further agrees that the CITY and its officers and
employees shall be saved harmless by the USER from any of the work herein under the terms of this
permit and that all of said liabilities are hereby assumed by the USER.
DAaSIED this �� day of �O�Qm�e� , 200-
Brn presence of the Notary)
STATE OF FLORIDA
COUNTYOFDUVAL J
On this 4)>day of I 6&16 204, personally appeared before me, a Notary
Public in and for said unty and State, Chj i S L4)()ted , the property owner of
-75/X4+1 owtic.q e ci p, rI'V_k ' Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
AW PNotary Public State of Florida
Public in fo ounty and State �' � AmberAtteberry
My Commission EE 850279
oft P Expires 11/08/2016
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
Ricky L. Carper, Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
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