Permit 781 Jasmine StreetCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000933 Date 7/26/10
Property Address 781 JASMINE ST
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation 0
----------------------------------------------------------------------------
Application desc
WELL NOT DONE PERMIT EXPIRED
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
CAUSEY OWNER
781 JASMINE STREET
ATLANTIC BEACH FL 32233
----------------------------------------------------------------------------
Permit WELL PERMIT
Additional desc .
Permit Fee 75.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date 1/22/11
----------------------------------------------------------------------------
Special Notes and Comments
Seperate permit required for electrical
connection/wiring to new pumps
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- -------
Permit Fee Total
Plan Check Total
Grand Total
75.00 75.00 .00 .00
.00 .00 .00 .00
75.00 75.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORH)A
BUILDING CODES.
t ~ j~L~J~J' ~
J _' (, `~
r _. _. __.. ____. _.- _
- __ ____-
5 -
., .__... _.._ ..~_-. V~
CITY OF ATLANTIC BEACH
WELL PERNIIT APPLICATION
Date ~` ~'/~ ^ ~l/
Owner's Name•.~ L' ~~,~ ~aU c° GjAddress: ~O ~ c / Gr S~~/.ve ST
Well Address (if different than above):
Well Location on Property (i.e. northeast corner, etc.),,(/,~ ~,.~,~ S~f ~..~
Well Installation Contractor: ~/~~~/b-f W~//,~~~/~,rrf !~ ~-
Contractor License No.: Phone: ~.~av/d FAX:
Contractor Address:,d~ ~~~ 3j /~,~'~ ~/~~/ ~L~i~ 3 `lam-~j~- j~
Check Use of Well: Domestic Irrigation~~Other
Estimated- Well Depth~~ Casing Depth~~ Screen Interval from~3°tol~d
Well Diameter: 2 ~ Casing Material ~
Is address currently connected to the City water system?~-
Is address currently connected to the City sewer system?~~_
Has a Well Permit been obtained from the City of Jacksonville?~'~~Permit #~0 8Y-~C9~~~
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). ,(~~
If permit is required, note Permit Number and attach a copy.
NOTE: WHENA WELL IS INSTALLED ON YOUR PROPERTY, YOUMUST
INSTALL A REDUCED PRESSURE ZONE TYPE BACSFLOW PREVENTER ON
THE CITY WATER SERVICE, ON_ THE CUSTOMER'S SIDE OF THE METER.
THE BAC%FLOW PREVENTER MUST BE TESTED BYA CERTIFIED TESTER
AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES
DEPARTMENT.