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Water-Sewer Tap RequestWater System Development Charge $ Sewer System Development Charge $ Water Meter Only $ Reclaim Meter Only $ Water Meter Tap $ Sewer Tap $ Cross Connection $ Other $ TOTAL $ City of Atlantic Beach PUBLIC UTILITIES DEPARTMENT 902 Assisi Lane Jacksonville, FL 32233 (904) 247-5886 NEW WATER / SEWER TAP REQUEST Date Service Address Number of Units Commercial Residential Multi-Family New Water Tap(s) & Meter(s) Meter Size(s) New Irrigation Meter Upgrade Existing Meter from to (size) New Reclaim Water Meter Size New Connection to City Sewer Applicant Name Billing Address City State Zip Phone Email Applicant Signature Application # CITY STAFF USE ONLY All fees must be paid before meter set/establishing service. (Notes) APPROVED Date Public Utilities Director or Authorized Signature **THIS IS AN APPLICATION ONLY. ONCE FEES ARE ESTABLISHED, PLEASE NOTIFY THE UTILITIES DEPARTMENT IF YOU WOULD LIKE TO PROCEED WITH THE PERMITTING PROCESS AND A PERMIT NUMBER WILL BE ASSIGNED TO THIS APPLICATION.