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1330 Ocean Boulevard SS CITY OF ATLANTIC BEACH >1 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00001126 Date 9/21/10 Property Address . . . . . . 1303 OCEAN BLVD Application type description WELL PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc new well for heat pump ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ PRIDGEN, DONALD WILLIAMS WELL DRILLING INC 1303 OCEAN BLVD. P. 0. BOX 330567 ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 241-8489 ---------------------------------------------------------------------------- Permit . . . . . . WELL PERMIT Aaaitional desc . . Permit Fee . . . . 75 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/20/11 ---------------------------------------------------------------------------- Special Notes and Comments Seperate permit required for electrical v3nnection/wiring to new pumps A reduced pressure zone backflow preventer must be installed on the City water service, on the customer' s side of the meter when a private well is on the property. Backflow preventer must be tested by a certified tester and a copy of the results sent to Public Utilities . ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 75 . 00 75 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 112- CITY OF ATLANTIC BEACH WELL PERMIT APPLICATION Date— Owner's Name:,.V avil &1a'**4?C1J Address: Z 04,^vow 0 _Ifl 4,r Well Address(if different than above): Well Location on Property(i.e. northeast comer, etc.) .50 v 7/--4 Well Installation Contractor: &,�ell jV.^1 IZIA-r Contractor License No.: Phone:,�?A7-6,1.-0 FAX: Contractor Address:,,,R- Check Use of Well: Domestic_ Irrigation Estimated-Well Depth: Casing Depth: ;;-7 0 Screen Interval from.24 to Well Diameter: Casing Material tl Is address currently connected to the City water system?_ !V Is address currently connected to the City sewer system9 Has a Well Permit been obtained from the City of Jacksonville?.,112.Permit Does the well require a permit from the St. Johns River Water Management District? (Not required for wells under 2-inches diameter installed by resident or wells under 6- inches diameter if installed by licensed well contractor). &0 If permit is required,note Permit Number and attach a copy. NOTE.- WHENA WELL ISIIVSTALLED ON YOUR PROPERTY, YOUMUST VVSTALL A REDUCED PRESSURE ZONE TYPE BACKELOWEREVENTER ON THE CITY WATER SERVICE, ON THE CUSTOMER'S SIDE OF THE METER THE BACKFLOWPREVENTER MUST BE TESTED B YA CERTIFIED TESTER AND A COPY OF TRE RESULTS SENT TO THE PUBLIC UTILITIES DEPARTMENT. City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road 3 "21110 Atlantic Beach, Florida 32233-5445 1 Phone(904)247-5826 - Fax(904)UT�5845 E-mail: building-dept@coab.us Date routed: Cityweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 6�,"�d77, Department review required Yes No Building Applicant: Planning &Zoning Tree Administrator Project: Public Works blic si> Public Safety Fire Services N"'A F11 -WO U44 VW, Other Agency Review or Permit Required Review or Receipt Date of Permit V Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: KApproved. F]Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed bz!:Z Date: TREE ADMIN. Second Review: F]Approved as revised. FIDenied. P #RK Comments: < I C U ILITI S S J1 TY PUB S ETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. ElDenied. Comments: Reviewed by: Date: Revised 05/14/09 CITY OF ATLANTIC BEACH >1 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 19 Application Number . . . . . 10-00001126 Date 9/21/10 Property Address . . . . . . 1303 OCEAN BLVD Application type description WELL PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc new well for heat pump ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ PRIDGEN, DONALD WILLIAMS WELL DRILLING INC 1303 OCEAN BLVD. P. 0. BOX 330567 ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 241-8489 ---------------------------------------------------------------------------- Permit . . . . . . WELL PERMIT Additional desc . . Permit Fee . . . . 75 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date - - 3/20/11 ---------------------------------------------------------------------------- Special Notes and Comments Seperate permit required for electrical connection/wiring to new pumps A reduced pressure zone backflow preventer must be installed on the City water service, on the customer' s side of the meter when a private well is on the property- nd Backflow preventer must be tested by a certified tester a a copy of the results sent to Public Utilities - ----------------------- -------------------- ----------- -- ------ ---------- Charged Paid Credited ----Due--- Fee summary ---------- ---------- ---------- . 00 ----------------- 75 . 00 75 . 00 . 00 . 00 Permit Fee TotBLl .00 . 00 . 00 .00 plar, Check Total 75 - 00 75 . 00 . 00 Gra'adL 'rotal