87 19th St IRR23-0005 s A4 , IRRIGATION PERMIT APPLICATION FORINTERNALOFFICEUSEONLY
' of City of Atlantic Beach PERMIT# ,�Z3- �==
0 Building Department
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on >� 800 Seminole Road Atlantic Beach, FL 32233
(P)904-247-5800
SITE INFORMATION
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ADDRESS a '1 11 �T PROJECT VALUE C .
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Contractor/Owner Irrigation Self Certification Checklist
Irrigation Standards: Please review all of the following standards prior to signing the certification section.
❑ High Volume irrigation,if used does not exceed 60%of landscape/pervious area
* Example:Total lot area=5,500 sq.ft.; Impervious area=2,200 sq.ft.;Total landscape/pervious area=5,500-2,200=
3,300 sq.ft.; Maximum High Volume Irrigation=3,300 x 60%= 1,980 sq.ft.
❑ For lawns and turf areas that exceed 50%of the total landscape area of the lot,low volume irrigation may be used as
needed.
❑ At least one(1) moisture sensor shall be located in each irrigation zone.
❑ Emitters shall be sized and spaced to avoid excessive overspray on to impervious surfaces.
❑ A hydrozone plan must be submitted that indicate areas to be irrigated and shows low, moderate and high water use areas.
Plans may be prepared by property owners or contractors on a copy of the survey or a site plan.
❑ RPZ backflow preventer must be installed for all irrigation systems. Backflow preventers must be tested by a certified tester
and results sent to Public Utilities.
❑ Irrigation system shall be installed according to Section 24-178.
Permit becomes void if work does not commence within a six(6)month period or work is suspended or abandoned for six(6)
months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and
ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate
the provisions of any other state or local law regulation construction or the performance of construction.
OWNER INFORMATION ''
OWNER NAME CAA, I 0 <<Y 5 LA L- 15 4-77 P✓t PHONE# CIO II-z I q -0 3 I
COMPANY / /� OFFICE#
COMPANY ADDRESS ‘gD6 OA yi+0 K FAX#
CITY 7.1-0.-)( STATE I� PL ZIP CODE 32210 EMAIL fLS rwLg
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LICENSE HOLDER �arl IQ 1 c-Yi ;(,t,,.t JS 11r0 STATE CERT/REGISTRATION# 7'-.5 S " J et-4-
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SIGNATUR OF LICENSE HOLDER PRINT OR TYPE NAME DATE I
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Signed and sworn before me on this Ir day of re-k- ,21
023 by State of r
aCounty of D(Dv-c--
Identification verified: • d_NA
'j3�°b TONIGINDLESPERGER
Oath Sworn: ❑ Yes ip ';, MY COMMISSION#GG 353178
.j,•-.4oP' EXPIRES:October 6,2023
'•''`.`;''• Bonded ThruNotary Public Underwriters Notary Signature
My Commission expires
30 IRRIGATION PERMIT APPLICATION 11.10.2021
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