340 10TH ST - HEN PERMIT ti6NS1 $ — 000 (
-s %=5 '��l r'vi BACKYARD HEN PERMIT_ APPLICATION
,
J / . \
-J City of Atlantic Beach
i,-.),
�� Community Development Department
800 Seminole Road Atlantic Beach, Florida 32233-5445
'401319, Phone: (904)247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us
SECTION 1: PROPERTY INFORMATION
Property Address: 31/0 /0'`h S7 r'rr f JAN 1 1 2018 RE# 170038-ODIC)
Property Owner Information
Name:
1naneia Vc/de Z- ,.
Phone:( 90Y) 70%_ 7138
Email: arnanc/a ve /n//7._ €q it a i/- Cori Fax: ( —) -
Address: 3* /01-4 /t
h Sf- `J A`TIar►><7G State: f—L Zip: 32233
.f67c/,
Tenant Information(if applicable)
Name: Phone: -
Email: Fax: ( ) -
SECTION 2: ITEMS REQUIRED FOR APPROVAL
Backyard Poultry Seminar Certificate From the Duval County Agricultural Extension Office.
❑ Passed Inspection of Property Including coop/pen size, construction and location as well as screening.
Approval Letter from HOA (if applicable)
❑ Payment of$50.00 To be paid upon satisfaction of the above requirements.
/ Number Hens to be Kept on Property(limit of 5)
SECTION 3: SIGNATURES
I certify that the information contained herein is true and correct to the best of my knowledge. I hereby
acknowledge the terms of Ordinance 95-17-113 and swear to follow all requirements therein. Further, Ihereby
grant permission for the City of Atlantic Beach to enter the property listed above for the purpose of inspecting
for compliance and agree to remove all hens and associated structures upon the termination or expiration of
a to porary permit and/or this ordinance.
,, t wad, -ivy cfidd V / L 1/ ////6
Signature of Property Owner Print Name Date
State of (,0 r t (QC1 County of puq c1
Signed and sworn to before me this I 1 day of San u a i'( , 20 I(6, by A man dal Jia,, Q v4 O
- ��, ;'v'cil�a. JENNIFER JOHNSTON
Signa e of Nota Pu 1![L �a -;. . • MY COMMISSION#GG 042984
�V 1Nutl EXPIRES:October 27,2020
'•.;?d10;.° Bonded Thru Notary Public Underwriters
3QntnSJt)1/\irlSk r\
Print Name of Notary Public SEAL
❑ Personally Known
Produced Identification,Type of Identification: r 1_,O r ckCt & C-kk1 lir`-S �t L• Q-'15.Q
Updated: 1.17
01,Ap ''1 , BACKYARD HEN INSPECTION SHEET
J _ tCity of Atlantic Beach
7,-' Community Development Department
800 Seminole Road Atlantic Beach, Florida 32233-5445
j"i Ji3l c--)f- Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us
SECTION 1: APPLICANT INFORMATION
Property Address: 3 y(7 (a T4 ' lee-t- RE# 17003$'-CJ010
Name: Apic+nc%i Uc, !de 2_ Phone:( lChy) ?O8- 838
Email: /9/4-7cttldict vc idem 6‘r►')ci,'/<( ill Fax: ( ) -
SECTION 2: PROPERTY CHECKLIST
YES NO Notes
Single-family Use ,V] [ J
6 Foot Fence or Hedge k] [ ]
Proper Feed Storage V) I I
Coop/Pen Located in Rear Yard 4/] [ ]
SECTION 3: COOP/PEN MEASUREMENTS CHECKLIST
Minimum Recf
uirements Per Hen Provided Dimensions
#of Hens 1 2 3 4 5 Length Width
Min Coop Square Footage 3 6 9 12 15 3‘" x -2_ 3-
MM
3Min Pen Square Footage 10 20 30 40 50 `. 63" x -2.3'•
Provided Coop Square Footage: $7s" sq ft
Provided Pen Square Footage: _ /0,1 sq ft _
Provided Coop/Pen Total Square Footage(max of 100 sq ft): 15 •iCSsq ft
Provided Coop/Pen Height(max of 6 feet): 3 ft
SECTION 3: INSPECTION RESULTS
PASSED .Y
FAILED [ I
Corrective Action Required:
Inspector: �'� Date of Inspection: I--n- - IP
Updated: 1.17
w9.JI JQ91YZO .fin �� �7'
0 __ _ _ _ _ _ _
0
UF I IFAS Extension
'')
UNIVERSITY of FLORIDA `'� At roe
9C$SON'J-
,
.'1
c,
DUVAL COUNTY EXTENSIONSERVICE
44 Certifies that
0 i . 0
AMANDA VALDEZ ... ;, , ,.
,‘„,,
has completed the .
P
r¢
0 34 Backyard Poultry Production Seminar , 0
k
0 1' 1 I '
f z-Valjd -' 0
January 10, 2018
1 Date Extension Agent .1'
01 o
-°-
l0 low CQ � Q �;� lam ���