102B Ocean Gate Dr - Revocable Encroachment for Well Permit Attachment of for
Permit#_issued
�20_Atlantic Beach,FL 32233
Owner's Name:
R.E.#: --�.— Property Address: 10z C3
Subdivision: /� .� Lot#/Block#:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT,issued on this_day of
by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of
Florida, hereinafter referred m as "CITY" and t�i>=t tLr. r r
hereinafter referred to as"USER". of Atlanfic Beach; Florida,
WnTiESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to
eater upon the property of the City of Atlantic Beach for the purpose as described in the City of Atlantic
Beach Right-of-Way/Fasement permit numbers noted above(copies attached).
This work is genera]y described as: J rr`ti'fl �-t urQl( t h 0"� UI
W't.l L U V ..
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 an le to USER shall be
given by certified .mail, return recei
"75l rylt�y P - U r �},} (Wt 7. }requested,1a? the following address:
The deposittin og f 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 Developmeat 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 malting any changes from the approved 1
approval from the City of Atlantic Beach,Public Works pans and/or method, must obtain written
discretion of the CITY, be Department for said change. The USER shall,at the
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
USER stall 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 blic
nd i
limitations/requirements of pu
rights-of-way and other public land. USER further agrees that the CITY ats officer;and employees blic
be saved harmless by the USER from any of the work herein under the terms of this permit and that all
liabilities are hereby assumed by the USER. of said
DAED and SIGNED this OZt S Y of
-�� 2017
BY:
Property Owner �C
([o be signed in presence of the Notary) UPAAY
-SMU of Flurioa
STATE OF FLORIDA s FF 941841
ffm
COUNTY OFDWAL W APr2.2020
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Mimal itlYYArfn.
On this 7 1'r day of �.Cr..v7
and for said Com— 20/t' personally appeared before me, a Notary Public in
/OZ @ County and State, Aat
Bof
rac the eom� owner in
Md who execmed the foregoing instrument who acknowledged tome that he or shown tome to bee executednthe same�Y
and voluntarily and for the uses and purposes therein mentioned.
Notary Public in for said County and State
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
n lic W m Director
�nnf D:�Qe<6o.4o.r P.E.
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere,City Manager
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