381 Seminole Road TREE21-0019 Application VOIDTREE REMOVAL PERMIT APPLICATION
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
INSTRUCTIONS
1. Complete and sign this application.
2. Attach required exhibits as listed on application checklist.
3. Contact the Community Development Department if you have questions.
4. Submit the completed application and all required exhibits, along with
application fees to the Permits Desk at Atlantic Beach City Hall.
FOR INTERNAL OFFICE USE ONLY
FILE #
(] Legacy Tree $ 25.00
rSSingle-/Two-Family Residential $125.00
❑ Multi -Family Residential $250.00
❑ Commercial / Industrial $250.00
❑ Institutional / Other Non -Residential $250.00
SITE INFORMATION
ADDRESS
SUBDIVISION 45 fP) �7� 0+? YL BLOCK #
APPLICANT INFORMATION
NAME DLLNI�Z (��
ADDRESS 3 �� S�rntn�v L� IZ—�
RE#
LOT #
EMAIL C/�-ri= DF�-r`/�Cnrl,q?L, Lo,'�
CITY ,�-r^G�-//TIC. Br'YYftNSTATE � ZIP CODE 3�-x-33
WNER ❑ LEGAL AUTHORIZED AGENT
TREE REMOVAL PERMIT APPLICATION PACKAGE CHECKLIST
PLEASE ATTACH THE FOLLOWING EXHIBITS:
�* dditional information may be required, depending upon circumstances unique to individual applications
XHIBIT 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 applicant is not the owner
(EXHIBIT B - TREE INVENTORY and TREE PROTECTION PLAN
EXHIBIT C - TREE MITIGATION WORKSHEET
❑ EXHIBIT D - TREE MITIGATION PLAN
SITE PREPARATION CHECKLIST
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
❑ Mark property corners with stakes or paint
❑ 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 TREESAND NATURAL VEGETATION) AND ALL OTHER APPLICABLE CODES AND
ORDINANCES OF THE CITY OF ATLANTIC BEACH.
pkNc�2 90afafl3/18; I;Ll
PRINT OR TYPE NAME
J
DA 1'E
Prepared by:
Watson & Osborne Title Services, Inc.
2500 Monument Road, Suite 201
Jacksonville, Florida 32225
File Number: 06H2656
RECORD &RETURN TO:
Daniel R Burgo
381 Seminole Road
Atlantic Beach, Florida 32233
Warranty Deed
Made this May 19, 2006 A.D. By DEBORAH HANSEN, a married person, 3088 LOPINE COURT, NORTH
POLE, ALASKA 99705, hereinafter called the grantor, to Daniel R Burgos, a single person, whose post office
address is: 381 Seminole Road, Atlantic Beach, Florida 32233, hereinafter called the grantee:
C� (Whenever used herein the term "grantor" and "grantee" include all the parties to this instrument and
the heirs, legal representatives and assigns of individuals, and the successors and assigns of
corporations)
I� Witnesseth, that the grantor, for and in consideration of the sum of Ten Dollars, ($10.00) and other
valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises,
releases, conveys and confirms unto the grantee, all that certain land situate in Duval County, Florida, viz:
Lot 272 of SALTAIR SECTION NO 2, according to the Plat thereof as recorded in Plat Book 10, Pages) 15,
of the Public Records of Duval County, Florida.
Said property is not the homestead of the Grantor•(s) under the laws and constitution of the State of Florida in that
neither Grantor(s) or any members of the household of Grantor(s) reside thereon.
Parcel ID Number: 170433 0000
Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise
appertaining.
To Have and to Hold, the same in fee simple forever.
And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee
simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby
fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever;
and that said land is free of all encumbrances except taxes accruing subsequent to December 31, 2005.
erne Title Services, Inc.
..Mment Road, Suite 201
..sonville, Florida 32225
File Number: 06H2656
RECORD &RETURN TO:
Daniel R Burgo
381 Seminole Road, Atlantic Beach, Florida 32233
In Fitness Whereof, the said grantor has signed and sealed these presents the day and year first above written.
Signed, sealed and delivered in our presence:
N
Witness Printed Name Ic t /'d wMe/ /
DEBORA>EI HAVE
Address: 3088 LIPPINE COURT, NORTH POLE, 4V -W,
ALASKA 99705
Witness Printed Name_ � � _�-� pf,� Address:
State of
County of �,` 1�c
eal)
The foregoing instrument was acknowledged before me this 1 //7 ��day of May, 2006, by DEBORAH HANSEN,
a married person, who is/are perso
LOT Z�'Z BLOCK '� AS SHOWN ON MAP OF
AS RECORDED IN ��-T BOOK r° PAGES �'�
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EXHIBIT Co TREE MITIGATION WORKSHEET
';� City of Atlantic each
y� Community Development Department
800 Seminole Road Atlantic Beach, FL 32233 FOR INTERNAL OFFICE USE ONLY
(P) 904-247-5800 PERMIT #
List the species and diameter at breast height (dbh) of all trees identified on EXHIBIT B
ID
DBH
SPECIES
removing
preserving
replOacing
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