Permit Well 578 Beach Ave 2010 A Y . CITY OF ATLANTIC BEACH
, . $ ;� -- 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
�- INSPECTION PHONE LINE 247 -5826
Application Number 10- 00001108 Date 11/05/10
Property Address 578 BEACH AVE
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
WELL FOR IRRIGATION
Owner Contractor
MOSELY STACY TRUSTEE DESTIN WELL AND PUMP, INC
920 SORRENTO PL P 0 BOX 413
JOSEPH SCHERER MACCLENNY FL 32063
JACKSONVILLE FL 32207 (904) 739 -8216
Permit WELL PERMIT
Additional desc . WELL FOR IRRIGATION
Permit Fee 75.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 5/04/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 75.00 75.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 79.00 79.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Nov 05 10 11:17a Destin Well And Pump Inc 9128432726 p.2
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'WELL UFPERMIr APPLICATION
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' Well Address C
Well Location on Propait9 (Le.. northeast corner, etc.) _--- --
Well
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Contractor License No.: 7 5 Pbone:
Ca tac Address: PO •
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Caeck Use of Well: De c bsig� an Otl>Gt 30
Estimated Well. Depth: 0 cling Depth: - 0 Scrum Interval frao? to
Casing Material
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Well DismA--^ Cas
Is address currently anmected to the City water system?_______
Is address =Tartly connected to the City sewer sys ? YLS
Has a Well Pea'mit been obtained
from the City of dackgonavII1
Does the well ruquito a Few front the St. Jahus River Water Management
farwells installed .resit Anet ar wells under 6-
(Not inches diame installed licensed well contractor). v
If penult i requited, note Permit Number 1 ‘._ ' a'd attach a copy.
NOTE: WHEN A WELL I-S JINSTALLED ON YOUR PROPERTY, YOU MUST _
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. _ . pMER'fS SIDE OF � r . , t� _� .
t R9'1"Y i�AT R �N x � B � BYA TESTER
TNL RAMP COPY TS . TO THE PUBLIC UTILITIES
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DEPARTMENT.
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