1590 Maritime Oak Drive HENS20-0001 Final Permit PacketBACKYARD HEN PERMIT APPLICATIOT{
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, Florid* 32233-5445
Phone: (904) 247-5826 Far (904) 247-5W5 Email: Buitding-Dept@coab.us
SECTION 1: PROPERTY INFORMATION
Property Address: lSto l,\cx-c"h*-*-Oe-\L 0 ^*<RE#
Pronertv Owner Info rmation
Name:
'\..'' ,.-\ r..- .\ (.*- '.- \'\ "'-i
.-\-. *r phone:r I Y5rrttit - 3S'77
Email: J.auolhocD\*.-<i.L - LBA-Fax: (tlA
Address: lSto p\*.,-.Hs,.t-elci q*S.rr.ue . Pr(. d-City:zip:9 tasj
Tenant Information (if applicable)
Na*",'\ri!'\& t (.€ ".. \d"-i'\-6-f
Email: 9,ll"*\Ar*q, \F-L"t- B91a-1"-tso ' L-q',r*Fax:( ) X-
SECTION 2: ITEMS REQUIRED FOR APPROVAL /,t Jrt.I;_.j*?*
El--nacLyard Poultry Seminar Certificate Frorn ilre Duval County Agricultural lixtcnsion ()llice.'t li.';t*.iLr.t
I Passed Inspection of Property Including coopipen size. construction anrl location as well as screening.
I Approval Letter from HOA (if applicable)
n Payment of $50.00 l-o be paicl upon satisfaction of the above requirements.
A Number Hens to be Kept on Property (linit of 5)
SECTION 3: SIGI{ATURES
I certify that the infurnation contained herein is tnte and correct to the best of my htowledge. I hereb-v
acknov,ledge the terms of Ordinance 95-17-l l3 und swear to.follov, all requirements therein. Fttrlher, I hereby
grant permission.fbr the Ci4; of Atlantic Beach to enter the property* listed aboveJbr lhe purpose rlf inspeclittg
.for compliance and agree to remove all hens and associated structttres ttpott tlte lerminatiort or expiration of
a temporary permit and/or this ordinance.
^.-_ \\SEnature oI Properry Uwner
state of Ftr^A*County of
Signed and sworn to before me this _ day of ,20__, b-v
Signature of Notary Public
AS
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PrintName
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Prilt Name of Notary I'}ublic
I Personally Known
I Produced Identification, Type of Identification:
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Updated: 1.17
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HENS20-0001
1590 Maritime Oak Drive