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325 Country Club Lane 16-DRTV-157 v ( Co -DR��� Is7 r TREE & VEGETATION REMOVAL- PERMIT APPLICATION I . INSTRUCTIONS I .45,77z)„, City of Atlantic Beach (1) Complete and sign this form. +F _,A, Department of Community Development (2) Attach the required supporting exhibits as listed on the application \- 800 Seminole Road Atlantic Beach,FL 32233 checklist. ��,,,,� (P)904 247-5800 (F)904 247-5845 (3) Contact the Department of Community Development if you have questions or need assistance completing the application or Single /Two Family Residential $125.00 determining which exhibits are required for your particular project. fl Multi-Family Residential (4) Submit this form, along with all required exhibits and payment to $250.00 the City of Atlantic Beach,and in the appropriate amount according r Commercial/Industrial $250.00 to the application fees listed to the right,to the reception desk at I f' Institutional/Other Non-residential $250.00 the Building Department. r !- .F, e — ----_ .1 Application#TREE - SECTION I-SITE INFORMATION PHYSICAL ADDRESS 32r /.' if an address has not been assignealt this property,contact the AB Building Department at(904)247-5826 to request an address. SUBDIVISION BLOCK LOT RE# SECTION II-APPLICANT INFORMATION 17 OWNER n LEGAL AUTHORIZED AGENT* NAME OF APPLICANT (-).) LL } ADDRESS OF APPLICANT ZS, Cy ,.+ ' PHONE .102,31-1,, � L' v a �i�C slip CELL saZ„ • , lb EMAIL SECTION III-TREE&VEGETATION REMOVAL REQUEST I REQUEST THAT THE TREES&VEGETATION ON THE ABOVE DESCRIBED PROPERTY AND INDICATED ON THE ATTACHED REQUIRED EXHIBITS BE APPROVED FOR REMOVAL,AS PROVIDED IN THE CITY OF ATLANTIC BEACH VEGETATION CODE,CHAPTER 23, FOR THE FOLLOWI REASONS(check all that apply): )P' Vegetation(trees)are difficult to maintain/owner dislikes. 1-- Trees are dead,diseased or so weakened by age,storm,fire,or other injury so as to pose a danger to persons,property, improvements or other trees. n Vegetation(trees) pose a safety hazard to pedestrian or vehicular traffic or cause disruption to public utility services. JiVegetation(trees)pose a safety hazard to buildings or structures. F. Vegetation(trees)completely prevent access or cross access to a lot or parcel. f' Vegetation and/or trees prevent development or physical use. It is the intent of this provision that a permit shall be granted for the removal of vegetation and/or trees when the applicant has demonstrated an effort to design or locate the proposed improvements so as to minimize the removal of vegetation and/or trees. I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED WITHIN THIS APPLICATION IS CORRECT AND I AGREE TO COMPLY WITH ALL PROVISIONS OF CHAPTER 23,PROTECTION OF TREES AND NATURAL VEGETATION,AND ALL OTHER APPLICABLE CODES AND O DI CES OF THE CITY OF ATLANTIC BEACH. -\ SIGNA URE OF APPLICANT �r Za/6 DATE FOR INTERNAL OFFICE USE ONLY FRONTAGE FLU ZVAR ESA SR-1 x �, �-i'C � DEPTH ZONING UBEX H/H AREA SR-2 ISA WAIV OAB -- _�y Tree&Vegetation Removal Permit Application_versionot.o1.09l • EXHIBIT A. LETTER OF AUTHORIZATION .. � DR'TV 10- • is hereby authorized to act on behalf of the owner(s)of those lands described within the attached application,and as described in the attached deed or other such proof of ownership as ma be required by the City of Atlantic Beach in applying for a development permit. y BY: 1Vfj22------I Signatu e o Owner or Owner's Legal Representative git-,4 AO- Xi. 1 ,P. =: Printed Name /Z., Z►^ co,r",Z C c „6 G.!1-m,6- Mailing Address 20 a -s fl 4.u# Z4>z--s 51-Oa ,4// 4 �i Pone Ce Fax //s ��,�( tie•C/^'1 Emai State of: = c County of: L) � e_____0, Sign a d sworn before me on thisZ-9day o J ��— ' Y cG.7 Identification verified: C . Ct9 — 9 ZS -7z_d .,i, -0 Oath sworn: in Yes n No , � TONI 1FSPE GER di 4P F 924951 — , � e/ ,,, • MY COMMISSION Notary Signature "`' '�' ::,9,"` EXPIRES:October 6,2019 '�'��`' Publ c U�erwr tars "''' d; Bonded Thru Notary Rf, " My Commission expires: 1 1 I I EXI-IIBITA_Letter ofAuthorization_vo5.1o.io • • • ,� EXHIBIT B. TREE&VEGETATION INVENTORY- - Application#TREE - -_ - - - For the removal of 25 trees or less associated with major development, redevelopment or renovation of or addition to single- family or two-family structures,or the removal of 25 trees or less associated with the renovation of or addition to all other non- residential uses,use the grid below to create a Tree&Vegetation Inventory. Note the scale on the bottom of the page. Plot the boundaries of the subject property,as well as existing and proposed structure(s). Label all adjacent streets. Note the location of trees to be removed with an "X". Note the location of trees to be preserved with"f " (mitigation) trees with "O". Number all trees, whether to be removed, d 'or replaced,t the and listis location B replacement Vegetation Mitigation Worksheet. preserved and on EXHIBIT C. Tree & C.k ■■_11111111111111111111111117 ■ITI1U. 111, ■ _ I MK T 1111111111111 ir 11111M - Ile, g filini 1 ril,„"„,,,n,„,..NR,,,,:i....I. ,, ,■ _imil___....J. ......imminal___ _ ___ il. ■ _____ ,____ ■• P■VP Ow1111Na 111111111111111111111111111_ � ati 1111 ■ 1111 ..isami _ _______._ pl �%■ ..i ■r ik... II,t / 111Oiti , iN (Pi Pc1/4 Yr IIIiii inti- i Pc4 I Eiti III 2.111111111111 III III I PREPARED BY: AI >;t� - , SCALE: 1 SQUARE_ ! R 0A- b 111 ____„• EXHIBIT B Tree&Vegetation Inventory-version 01.01.09 • C 0 V M 72'/ L v .d LA I V r f ' EXHIBIT C. TREE VEGETATION MITIGA TION WORKSHEET Application#TREE - TO BE COMPLETED BY THE-APPLICANT TO:BE COMPLETED BY CITY STAFF ID DBH SPECIES CQNDITIQN ,^X :AO ACV:.! •T'YPE ZO ©_11ayh ----_�SCONIMEIVT1 �_1111111111111 ---_____ 6 1112M111111111111111.11111111111111 11111111111111111111110 111111.0 8or Ira 19111111111111111111.11111111111111111111111111111111111 IMIIIIMMINIIMMIMMINIMME 111111111111 _`M ---_____ nem 1111=11111111111 NM 1111111111111111. IIIMIIIIIIIIIIIIIMIIIIIIIIIIIIIIINIIIIIIIIIIIIIIIII 111111111111111111111111111111111.111111111111111111111111111111111111111111.111.1 MEN 111111111.1111111111 NEM Inn= 1113111111 111111111111111111111111111111111111111111111 1111.1111111 111111111 1111111111MMIIM111111111111111111111111N1111111111111111111 i6 En �8 17 MI -��__lir NE v' N 11111111111111.1 11111111111111111 =__ 111111111111111111 1 11111 zo MN --1111.111111.11111111111111111111 _ ®_ lii __- 2411111111111.11111. saNIIIIIIII _•- 26_ _____11111111111111 z7_ 111111111111.1111111111111111111111111 111111111111111111111.1 MUM ��__ 28_ ---___=_ WV ---_ Min min. iiiiIiiimmammunimminumminimmi 32ammisinson -- ___ EMI111 1111111111111111111 NEM ---___ ®__ =--_____ 111111111111 ame _= :iiiIii ---_____ 40 ___ 41 11.1111111111111111111111111 MEM__ 11111111111.111111111111 MI ---_____ Ma _ ---___ �ii 111111111111.ii__ =--______ IIIIIIIIIIIIIIIIINIIIIIIIIIIIIIIIII NIB 11111111111.1 ai 48_ --- _111111111111111111111111 NMI iii _= 50- 1.111111111- --- _ _ 1 Of 2 EXHIBIT C Tree&Vegetntion Mitigation Worksheet_versionoi.o�.o� OLATLANTIC BEACH rl PERMIT RECEIPT V~ s.i......___.} `-- J,31Jr PERMIT DESCRIPTION: TREE REMOVAL PERMIT TO PROCESS CHECK PERMIT NUMBER: 16-DRTV-157 ?PSC) ADDRESS: 325 COUNTRY CLUB LN AVG p 4 216 cN OWNER: C1�� OF P.��PN11G ��P ). DATE ISSUED: \J 0 FEES DUE: TREE REMVL SNGL/TWO FMLY $125.00 Totals: $125.00