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Permit Well 2010 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00001033 Date 8/20/10 Property Address . . . . . . 255 SHERRY DR Application type description WELL PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc new shallow well ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ OLIVIERI HULIHAN TERRITORY 255 SHERRY DRIVE P.O. BOX 331268 ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 270-8377 ---------------------------------------------------------------------------- Permit . . . . . . WELL PERMIT Additional desc . . Permit Fee . . . . 75 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 2/16/11 ---------------------------------------------------------------------------- Special Notes and Comments Seperate permit required for electrical connection/wiring to new pumps A reduced pressure zone backflow preventer must be installed if irrigation is installed OR if there is a private well 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. .T City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road A) Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 5� Department review required Yes No . Building V-1p Applicant: Planning &Zoning Tree Administrator Project: Pu r s �fic Utilities- Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By 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: []Approved. ODenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review, DApproved as revised. F�Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: FlApproved as revised. []Denied. Comments: Reviewed by: Date: Revised 05114109 OR I CITY OF ATLANTIC BEACH WELL PERMIT APPLICATION Date 7-0 Owner'sName: '9//'V/'C//A' ddress: Well Address (if different than above): Well Location on Property(i.e. northeast comer, etc.) C(A X�'j Z7 Well Installation Contractor: Contractor License No.:- 7 376 Phone: Z- i -rtro S'r FAx: —2 ?o 2 D Contractor Address: lee7Z ,/,— e-21 V' .1 Check Use of Well: Domestic Irrigation Other Estimated- Well Depth: Casing Depth: Z..,42 Screen Interval from.,Z&toAe_ Well Diameter: I Casing Material__e� Is address currently connected to the City water system9 Is address currently connected to the City sewer system? Has a Well Permit been obtained from the City of Jacksonville?,t/v Permit#_/1-0 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 17VSTALL A REDUCED PRESSURE ZONE TYPE BACKFLOWPREVENTER ON THE CITY WATER SER UCE, ON THE CUSTOMER'S SIDE OF THE METER. THE BACKFLOWPREVENTER MUSTBE TESTED BYA CERTIFIED TESTER AND A COPY OF TRE RES UL TS SENT TO THE PUBLIC UTILITIES DEPART M ENT Graham Shirley From: Kaluzniak, Donna Sent: Friday, August 20, 2010 10:24 AM To: Graham Shirley Subject: RE: Shirley, approved in AS400,will send hard copies through interoffice mail -Donna From: Graham Shirley Sent: Friday,August 20, 2010 10:09 AM To: Kaluzniak, Donna Subject: