HENS19-0003 925 Seminole Road (Ross) s y''�` ,,
BACKYARD HEN INSPECTION SHEET
=� � City of Atlantic Beach
;� � 'j
Community Development Department
800 Seminole Road Atlantic Beach, Florida 32233-5445
0 Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us
SECTION 1: APPLICANT INFORMATION
Property Address: C1 2-S Se/v) ' ' e j e 0.1r I RE#
Name: I I lac., Cr Phone: ( ) -
Email: Fax: ( ) -
SECTION 2: PROPERTY CHECKLIST
YES NO Notes
Single-family Use I /1 1 1
6 Foot Fence or Hedge [ ✓I I I
Proper Feed Storage [✓I I I 11•5‘M LS/Ara6f1
Coop/Pen Located in Rear Yard [vI [ I
SECTION 3: COOP/PEN MEASUREMENTS CHECKLIST
Minimum Requirements Per • en Provided Dimensions
# of Hens 1 2 di. 4 5 Length Width
Min Coop Square Footage 3 6 I 12 15 / Q/ x 62/ pen
Min Pen Square Footage 10 20 30 40 50 <N 'Z' x ?j' Coup
Z
Gal
Provided Coop Square Footage: 6 sq ft z 3. 3_ .s,7 F 4: x 5 C ,
,n to e5Provided Pen Square Footage: � O sq ft ' 3.1 ? 5 et, -f i q I
I� Provided Coop/Pen Total Square Footage (max of 100 sq ft): b 3 sq ft 5 �� x I Z pen
Provided Coop/Pen Height(max of 6 feet): 3 ft q I 5 ' _+
SECTION 3: INSPECTION RESULTS
PASSED [/1
FAILED [ ]
Corrective Action Required:
Inspector: Date of Inspection: 7 (2)-/ (GI
Updated: 1.17
$ ''\ BACKYARD HEN PERMIT APP
Wailg - - -
�` l City of Atlantic Beach
Community Development DeparD; t 3' I 1 �Gf
800 Seminole Road Atlantic Beach,Florida 32233-5445
'111,05W-ft- Phone: (904)247-5826 Fax: (904)247-5845 Email: Building-Dept@coab.us
SECTION 1: PROPERTY INFORMATION
Property Address: <j Jef"-,,r1e CA c ct- - A--) 3 RE#
Property Owner Information
Name: --x1\ 0-CAX c c f-eSS Phone: P64)31)- -6131
\
Email: ' , \ 14"t�C °-COBS P. .,ko, „C d r'"l Fax: ( ) -
Address: i,5 Ste,:., ,��1.e eel . City: 0,6 . State: Zip:3-4,0-3 3
Tenant Information(if applicable)
Name: Phone: ( ) -
Email: Fax: ( ) -
SECTION 2: ITEMS REQUIRED FOR APPROVAL
U Backyard Poultry Seminar Certificate From the Duval County Agricultural Extension Office. 1 �l 1
El Passed Inspection of Property Including coop/pen size,construction and location as well as screening.
❑ Approval Letter from HOA(if applicable) Opt
n Payment of$50.00 To be paid upon satisfaction of the above requirements.
3 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, I hereby
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 temporary permit this ordinance. AI .7/4)? ,)C}%C
gnature of'roperty Owner Print Name f)ate
State of FL County of T v ft L...
Signed and sworn to before me this day of Ai�� , 20/1 , by -3 t \\ S .
If --) Q _ Uut Li
Signa of '►, . Public ; 1;a?q� JENNIFER N#GG0N
4; MY COMMI5SION#GG 042984
� *` ��' °* EXPIRES:October 27,2020
�Q f .fit. ;�\o
JUN(�( 1 C 3 ,Il S-\j(1 s�c,• ;;: Bonded Ttvu Notary Public Underwriters
Print Name of Notary Public SEAL
❑ Personally Known
Produced Identification,Type of Identification: F L- 3.-0 J A \S \.t L e n,\--
Updated: 1.17
1/1 VIAC)8
+ /,sr( -nock
July 15, 2019
Dear City of Atlantic Beach,
We hope you are well. We have completed our 3 hour course in Backyard Poultry,
covering chickens, chicken anatomy, poultry diseases, chicken incubation,
ordinances, poultry housing, chicken breeds, fowl rearing, and more. The all-
encompassing course was phenomenal! Attached is our certificate. Please accept
our application for a chicken permit along with our course completion.
We look forward to the next steps in this process.
Thank you for your time. - 1!
Sincerely, JUL 1 5 2019
Jill and Xavier Ross
925 Seminole Road
Atlantic Beach, FL 32233
ems
DIVISION OFA RIUI E
RESEARCH 6T EXTENSION
thliversity of Arkansas System
Course Completion Certificate
This is to certify that
Jill ross
has completed the course
Backyard Poultry
on
July 14, 2019
a
Ui- DMSION OF AGRICULTURE
RESEARCH 6t EXTENSION HOME COURSE CATEGORIES PROFILE
University of Arkansas System
Jill rocs 4 0f 1i ® in
Jill ross
Home ► Dashboard ► Grades ► IBYP_16 ► User report
Calculated Contribution to course
Grade item weight Grade Range Feedback total
Ir Introduction to Backyard Poultry
• Review Common Ordinance and - 90.00 0-100 -
Rules Quiz
41. Course Evaluation - 100.00 0-100 -
• Housing Requirements Quiz - 90.00 0-100 -
• Nutrition Principles Quiz - 100.00 0-100 -
iii Poultry Reproduction Quiz - 100.00 0-100 -
• Disease Recognition Quiz - 86.67 0-100 -
Commonly Seen Diseases Quiz - 85.71 0-100 -
", Control and Prevention Quiz - 100.00 0-100 -
Yy Poultry Welfare Quiz - 80.00 0-100 -
Breeds of Poultry Quiz - 90.00 0-100 -
• Lighting Requirements Quiz - 100.00 0-100 -
X- Course total - - 0-100 -
Simple weighted mean of grades.
rt ADMINISTRATION
Course administration
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