1611 W Linkside Dr TREE21-0038 Single Family •
Y1I--v TREE REMOVAL PERMIT APPLICATION
1� City of Atlantic Beach
✓ Community Development Department
j FOR INTERNAL OFFICE USE ONLY
� 800 Seminole Road Atlantic Beach,FL 32233
0; 19',- (P) 904-247-5800 FILE #
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. ❑ Institutional/Other Non-Residential $250.00
SITE INFORMATION
l
ADDRESS /.- a/ i/ f ,��j •E# -7 -379—�(,3%
SUBDIVISION t ,IW L:-/ i/ 01? P BLOCK# LOT# /cie)
APPLICANT INFORMATION
NAME feS�II CSJ 45- / EMAIL 41 j ll D/b? ,,te 71-
ADDRESS /(p// r%'6 y/( ;J pr,jjJ CITY Q4 P& ec4STATE j ZIP CODE(17 33
PHONE#4L 03- 7 CELL 10 4f a3— o, $OWNER ❑ 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)
ri EXHIBIT A(Option 2)-LETTER OF AUTHORIZATION: Please complete if the applicant is not the owner
• EXHIBIT B-TREE INVENTORY and TREE PROTECTION PLAN
fJ EXHIBIT C-TREE MITIGATION WORKSHEET
Ill 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 TREES AND NATURAL VEGETATION)AND ALL OTHER APPLICABLE CODES AND
ORDINANCES OF THE CITY OF ATLANTIC BEACH.
0 . `IA& sem., 4-6[-/le 5fi 0/ 4‘3.7-1
' T' "i-- • •• PRINT OR TYPE NAME DATE
02 TREE REMOVAL P" 4•PLICATION 03.01.2018
,
oL-livrr, EXHIBIT A: LETTER OF AUTHORIZATION
tl .I 'tI City of Atlantic Beach
•-! Community Development Department
yr 800 Seminole Road Atlantic Beach,FL 32233 FOR INTERNAL OFFICE USE ONLY
_on q (P)904-247-5800 PERMIT#
OWNER INFORMATION NAME 5re5(4. Gilevy PHON(tr,7) J
" 7
ADDRESS (&// //it's V, Pe W CELL#6;o1-1)?O3 ,. /6 to?
CITY ,l/Q, ;C, / e 4 STATE/ ZIP CODE 3 ,2_33
AGENT INFORMATION
NAME 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
r
�, � wj �'� 5N0----L ( LeD60) D� ��`7� 7EIRITOR
SIGNATURE OF OWNER#2 PRINT OR TYPE NAME DATE
Signed and sworn before me on this day of 0 ze t7 , 7.62-1 by State of
County of
Identification verified:
Oath Sworn: ❑ Yes ❑ No
Notary Signature
My Commission expires
02 TREE REMOVAL-EXHIBIT A:Letter of Authorization 03.01.2018
-1=-'''1 ;{ EXHIBIT B: TREE INVENTORY and PROTECTION PLAN
�'',f City of Atlantic Beach
- s; Community Development Department
J FOR INTERNAL OFFICE USE ONLY
800 Seminole Road Atlantic Beach, FL 32233
0131>V (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
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.
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PREPARED BY: SCALE: 1 SQUARE=
02 TREE REMOVAL-EXHIBIT B:Tree Inventory and Protection Plan 03.01.2018
•
01.1-10J:0,, EXHIBIT C: TREE MITIGATION WORKSHEET
-4ill' IA City of Atlantic Beach
- '' Community Development Department
1.)17800 Seminole Road Atlantic Beach,FL 32233 FOR INTERNAL OFFICE USE ONLY
�;t (P)904-247-5800 PERMIT#
List the species and diameter at breast height(dbh)of all trees identified on EXHIBIT B
"HI= "0"=
ID DBH SPECIES COMMENTS(for use by City Staff)
removing preserving replacing
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5
6
7
8
9
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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
OI
.r:1- r r;.�� EXHIBIT D: TREE MITIGATION PLAN
*''\ City of Atlantic Beach
Community Development Department
J r 800 Seminole Road Atlantic Beach, FL 32233 FOR INTERNAL OFFICE USE ONLY
J;t�>r v (P) 904-247-5800 PERMIT#
Please identify the location,species and size(caliper inches)of ALL trees to be planted for mitigation credit in the area below or on a
separate site plan. Please include existing and/or proposed buildings and any street names for reference points.
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PREPARED BY: SCALE: 1 SQUARE=
02 TREE REMOVAL-EXHIBIT D:Tree Mitigation Plan 03.01.2018
rs � {, EXHIBIT B:TREE INVENTORY and PROTECTION PLAN
br' # City of Atlantic Beach
Community800Seminole DevelopmentRoadAtlantic DepartmentBeachFL 32233
S AMPLE
FOR INTERNAL OFFICE USE ONLY
,
(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"[)"
• 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
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.
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PREPARED BY: SCALE:1 SQUARE=
02 TREE REMOVAL-EXHIBIT B:Tree Inventory and Protection Plan 03.01.2018
,
.s zt ., EXHIBIT C: TREE MITIGATION WORKSHEET
0._ ,;',, City of Atlantic Beach
1i+ i Community Development DepartmentM p
800 Seminole Road Atlantic Beach,FL 32233 FOR INTERNAL OFFICE USE ONLY
7#11111111r1:_L`7- (P)904-247-5800 PERMIT#
List the species and diameter at breast height(dbh)of all trees identified on EXHIBIT B
ID DBH SPECIES X H 0"= COMMENTS(for use by City Staff)
removing preserving replacing
1 10" Palm •
2 10" Palm •
3 10" Palm •
4 20" Sycamore •
5 13" Elm •
6 24" Live Oak •
7 6" Holly •
8 14" Pine •
9 11" Palm •
10 17" Pine •
11 10" Palm •
12 5" Oak •
13
14
15
16
17
18
19
20
21
22
23
24
25
02 TREE REMOVAL-EXHIBIT C:Tree Mitigation Worksheet 03.01.2018
Florida DRIVER LICENSE
..,..G421-790-56-550-0
•GILLESPY
2SUSAN JENNIFER
• 21591 LINKSIDE DR W
ATLANTIC BEACH.FL 32233-7318
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CLASS:E-Any rwn<amiarcul vett with a GWR<25.001 M
or any RV
REST A-Cm Leases
END None -
REPLACEMENT LICENSE REQUIRED WITHIN 30 DAYS
OF ADDRESS OR NAME CHANGE
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