303 6th St TREE20-0029 , '`f TREE REMOVAL PERMIT APPLICATION
_'YilliV ► City of Atlantic Beach
c Community Development DepartmentI 10 iFORINTERNALOFFICEUSEONLY
r 800 Seminole Road Atlantic Beach, FL 32233
_J;tl>' (P) 904-247-5800 FILE# rREL ZO - 00 C Cly
INSTRUCTIONS ❑ Legacy Tree $ 25.00
1. Complete and sign this application. ❑ Single-/Two-Family Residential $125.00
2. Attach required exhibits as listed on application checklist. ❑ Multi Family Residential $250.00
3. Contact the Community Development Department if you have questions.
4. Submit the completed application and all required exhibits,along with ❑ Commercial/Industrial $250.00
application fees to the Permits Desk at Atlantic Beach City Hall. E Institutional/Other Non-Residential $250.00
SITE INFORMATION
ADDRESS 5 c 'j ( ' 4--. RE#
SUBDIVISION A / \ -\--'c. $-evLj) BLOCK# e LOT# 2- <i- "{
APPLICANT INFORMATION
NAME CO-10 +. l WOO I` EMAIL -j07-)1/4..000c ® Ci (kx 1 . C C1'1'`
ADDRESS SOT (J\'‘ Si— CITY Ae STATEIP CODE 3 22-33
--TL
PHONE# '(OLI (-q iq 5 2°0 CELL# 'OWNER n LEGAL AUTHORIZED AGENT
TREE REMOVAL PERMIT APPLICATION PACKAGE CHECKLIST
PLEASE ATTACH THE FOLLOWING EXHIBITS:
*Additional information may be required,depending upon circumstances unique to individual applications
❑ EXHIBIT A(Option 1)-PROOF OF OWNERSHIP:Copy of Warranty Deed that verifies record of owner(Clerk of Courts)
❑ EXHIBIT A(Option 2)-LETTER OF AUTHORIZATION: Please complete if the applica nt is not the owner
❑ EXHIBIT B-TREE INVENTORY and TREE PROTECTION PLAN
❑ EXHIBIT C-TREE MITIGATION WORKSHEET I"' 0 2020
❑ EXHIBIT D-TREE MITIGATION PLAN
P''" 1;n" D^n,rtrmpnt
SITE PREPARATION CHECKLIST, .'� 'c-' FL
PLEASE PREPARE YOUR SITE AS FOLLOWS:
/Mark all trees identified for removal with RED or ORANGE flagging,paint or tape
�,/ Mark all trees identified for preservation with BLUE or GREEN flagging,pain or tape
M Mark property corners with stakes or paint
F Barricade all trees to be preserved on the property at the dripline
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS CORRECT. I AGREE TO COMPLY WITH ALL
PROVISIONS OF CHAPTER 23(PROTECTION OF TREES AND NATURAL VEGETATION)AND ALL OTHER APPLICABLE CODES AND
ORDINANCE THE CITY OF ATLANTIC BEACH.
I a,,e)6 �,„,4 '7, y. Zo2O
SIGNATURE
OFT
AP' IR,NT PRINT OR TYPE NAME DATE
02 TREE REMOVAL PERMIT APPLICATION 03.01.2018
,rt4. EXHIBIT A: LETTER OF AUTHORIZATION
11 - City of Atlantic Beach '
a r Community Development Department
VOW 800 Seminole Road Atlantic Beach, FL 32233 FOR INTERNAL OFFICE USE ONLY
... (P) 904-247-5800 PERMIT#
OWNER INFORMATION , ^
NAME C Z> 1n (t)oo v, PHONE# &14 ' cJ 298
ADDRESS 2, o Ur)- t— CELL#
CITY /` c , `J ' STATE \� ZIP CODE 3 ZZ 3
AGENT INFORMATION
NAME / -,- t PHONE#
ADDRESS CELL#
CITY STATE ZIP CODE
is hereby authorized to act on behalf of
the owner(s) of those lands described
in the attached application and as described in the attached deed or other such proof of ownership as may be required
in applying to the City of Atlantic Beach, Florida,for an application related to a Tree and Vegetation Removal Permit.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Authorized Agent
IP
Cair0 yr Oao (k '7, 2yt. 2o Zo
SIGNATURE W E' PRINT OR TYPE NAGE DATE
SIGNATURE OF OWNER#2 PRINT OR TYPE NAME DATE
Signed and sworn before me on this day of , by State of
County of
Identification verified:
Oath Sworn: ❑ Yes ❑ No
Notary Signature
My Commission expires
02 TREE REMOVAL-EXHIBIT A:Letter of Authorization 03.012018
r" rit.
EXHIBIT C: TREE MITIGATION WORKSHEET
City of Atlantic Beach
si Community Development Department
tv-4, v~ 800 Seminole Road Atlantic Beach, FL 32233 FORINTERNALOFFICEUSEONLY
o�svr (P) 904-247-5800 PERMIT#
List the species and diameter at breast height(dbh) of all trees identified on EXHIBIT B
ID DBH SPECIES XIII ( — COMMENTS(for use by City Staff)
removing preserving replacing
1
30
Co,617) (ct 1-7c0/171-
2 3' a J� v o
cl
3 ��
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
02 TREE REMOVAL-EXHIBIT C:Tree Mitigation Worksheet 03.01.2018
, •,s' 1r( EXHIBIT B: TREE INVENTORY and PROTECTION PLAN
1`:, City of Atlantic Beach
IJ ,
?) Community Development Department
�� / FOR INTERNAL OFFICE USE ONLY
800 Seminole Road Atlantic Beach, FL 32233
"%6;;y>�'' (P) 904-247-5800 PERMIT#
TREE INVENTORY-Please sketch an inventory in the area below or attach a site plan showing all existing trees on the property below
that are 3"diameter at breast height(dbh)and greater.Please complete the following:
• Note the location of all trees to be removed with an"X" • Note the location of all trees to be preserved with"H"
• Number all trees and list on EXHIBIT C:Tree Worksheet • Show all existing and/or proposed buildings
TREE PROTECTION PLAN-(If you are doing construction on the site)-Please sketch and identify in the area below or on a copy of a I
certified tree survey the location of the protective barricades to be installed prior to construction. Section 23-32(c) requires protective
barricades to be installed around every tree or group of trees to be preserved.
PREPARED BY: SCALE: 1 SQUARE=
02 TREE REMOVAL-EXHIBIT B:Tree Inventory and Protection Plan 03.01.2018
1 LOT 5 LOT 3 LOT 1 ..
BLOCK 8 BLOCK 8 I BLOCK 8 1
100.00' (DEED) Il II
FOUND I/2- IRON PIPE N 79'54'44" E 99.78' (MEASURED) I.
NO IOENTlFRCATION 0.3• FOUND 1/2' IRON PIPE !i
_ I O.S' 15' 2.5• NO IDENTIFICATION
��
7,1'1 O
7.,• - o 50'0 x
50.0• III
FRAI.IE I ly!
L. A I N= _ t oil
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O BLOCK 8 I BLOCK 8 II
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7/ W
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0.5 l 50.0 I r-----•x--' l/ 1)1,ait r(tivr
11 of I
o x x I X sD.o x 2.2• V 1�0 [d0c S•�tJC -`>,-40 -
FOUND 1/2 IRON FIP� 1.5 r Cl_
i MLA-Lb
,, . ,' f
E
NO IDENTIFICATION
i.B•1 CORNER OF INTERSECTION �`�.t. b(A
FOUND 1/2- IRON PIPE I
S 80"04'4r W 100.11' (MEASURED) NO ISN `n�0" d �0 `' li
100.00' (DEED) (1 II.
6TH STREET
'
i
(40.0 RIGHT OF WAY) J
NOTESil
A6lEPTED BY: II
LEGEND: II
R = RADIUS —x— = FENCE
L = LENGTH = CONCRETE I
Ii
NOTES: II
1. BEARINGS ARE BASED ON THE ASSUMED BEARING OF N 10.OD'00- W
WESTERLY BOUNDARY UNE OF SUBJECT PARCEL ALONG THE REVISIONS E
2. BY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS UE WITHIN FLOOD ZONE
NATIONAL FLOOD INSURANCE MAP DATED APRIL 17. 1989. COMMUNITY NUMBER 120075, PANEL SHOWN 0001 ON
0 li
THE DATE DESCRIPTION
3. THIS SURVEY REFLECTS ALL EASEMENTS & RIGHTS OF WAY AS PER RECORDED PLAT &/OR TITLE COMMITMENT
IF SUPPLIED_ UNLESS OTHERWISE STATED. ND OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED_
I
4. THIS SURVEY NOT VALID WITHOUT THE ORIGINAL SIGNATURE AND EMBOSSED SEAL OF THE CERT1FYING-SURVEYOR. II
JOB ° 19107 1
R DATE OF FIELD SURVEY: 11-14-02 DATE OF ISSUE: 11-18-p2 li
�.,. SCALE: 1" = 30' it
CERTIFICATE
1!>'. N---7i
f?0I 2522 Oak Street 11
�i�%lI,.i Jacksonville, Florida 32204 1 HEREBY corn Y TMAT'THIS-SURVEY WAS UADE UNDER uY RESPONSIBLE CHARGE II
AND i+EETS THE itimut/I.f TECHNICAL STANDARDS AS SET FORTH BY THE FlORIOA II
c = (Phone) 904-389-5989 BOARD or PFioFC590lnL suRVEYORs AND MAPPERS IN CHAPTER 61017-6, FLONIUA
L (Fox) 904-389-6175 ADUB STRADVE •1,` • ANT TO
SECTION 472072. FLORIDA STATUTES_ i
rJE11i111iTI : . : ix•° MICHAEL J. AIE '.
UCENSED BUSINESS ft 6702 REGISTERED SURVEYOR AND MAPPE'
# 4879, 5502 STATE OF FLORIDA U
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