Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
sewer tap
CPityUBLofIC AtlanticUTILITIES Beach 902 Assisi Lane J Jacksonville, FL 32233 DEPARTMENT .-0fi j (904) 247-5834 NEW WATER / SEWER TAP REQUEST Date e() /74 Service Address f� C/ e car, 0/vd Number of Units ( Commercial in Residential 17:1_ Multi-Family[J 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 K1 t Applicant Name (�G© T V''(%U Z 27 ) 6-44,./-Ac.,) Billing Address `7 5 % Q&e4 -1 z%Atd City 6?-1-0A-1--(c. /'/ka GJ State t Zip 2 2 Phone Q6 / V / 4 L/ Email `J 7.f//'/ ill ' I72,-t!l d liyYl / Applicant Signature .c CITY STAFF USE ONLY Application # Water System Development Charge $ Sewer System Development Charge $ Water Meter Only $ Reclaim Meter Only $ Water Meter Tap $ Sewer Tap $ Cross Connection $ Other $ TOTAL $ (Notes) APPROVED Date Public Utilities Director or Authorized Signature ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED e (,1110-,.._ "SEP,/ e--.4-e-, ave-, .L i)ee �G / QtI P r ��iA/JAI �s � G6� 4Ai< akin �Ljczrdah DISC h