Permit Well 2100 Fairway Villas 2010 0 CITY OF ATLANTIC BEACH
�� p z; 800 SEMINOLE ROAD
a x .. M " 7) ATLANTIC BEACH, FL 32233
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I PHONE LINE 247 -5826
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Application Number 10- 00001411 Date 11/29/10
Property Address 2100 S FAIRWAY VILLAS LN
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
SHALLOW WELL
Owner Contractor
HIRTZ KORREEN ET AL DESTIN WELL AND PUMP, INC
2100 FAIRWAY VILLAS LN P 0 BOX 413
ATLANTIC BEACH FL 32233 MACCLENNY FL 32063
(904) 739 -8216
Permit WELL PERMIT
Additional desc . SHALLOW WELL
Permit Fee 79.00 Plan Check Fee . . .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/28/11
Special Notes and Comments
Seperate permit required for electrical
connection /wiring to new pumps
MUST INSTALL AND HAVE INSPECTED
BACKFLOW PREVENTER
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 79.00 79.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 83.00 83.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
y 1 r'}''tri , ( To be by the Building Department.)
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Building Department 800 Seminole Road /0 f //
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-, Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 • Fax (904) 247 -5845 Date routed:
ii >1' E -mail: building- dept @coab.us
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
De n t review re Yes , No
Property Address: Z /84 v /
P uilding
��1 �• £ G/ ing & Zoning
Applicant: f/lI'" Tree Administrator
��/ Public Works
Project: (A Public Utilities
Public Safety
Fire Services
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Review or Receipt Date
Other Agency Review or Permit Required 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: DApproved. ❑Denied.
(Circle one.) Comments: — �1 C a oL 6
BUILDING X.0 l
PLANNING & ZONING Reviewed by: Date:
TREE ADMIN. Second Review: Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
Nov 04 2010 3:49PM City of Atlantic Beach 904-247-5845 page 1
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1{ cITY OF ATLANTIC BEACH
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A J WELL PERMIT APPLICATION
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Owner's Name: KO r r /WV Address.
Well Address (if different than above): 14 " C -
Wen Location on Property (i.e. northeast corner, etc.) N r' 41-1"1 19S
Well Installation Contractor_ ` cam i i A S t'.--' 1
Contractor License No.: 7oS Phone: 73 ?-62 grAX: 7/ 2 4 g 13-ao 55
Contractor Address: PC 3r) i/1, ill4ectervAdlY ft 3W43
Check Use of Well: Domestic Irrigation �~ Other
Estimated- Well Depth: f2 V Casing Depth: Screen Interval from to ' C'
Well Diameter: 1 Casing Material rc/�.
Is address currently connected to the City water system? Y z 5
Is address currently connected to the City sewer system? )54,..5 �
!Y
Has a Well Permit been obtained from the City of Jacksonville? • Pewit #
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 oomtractor). NO 1 , 604 `/"
If permit is requited., note Permit Number and and attach a copy.
NOTE WHE, N A WELL I S INSTALLED ON YOUR PROPERTY, YO I T M US T
INSTALL REDUCED PRESSURE ZONE TYPE BACSFLOWP ON
THE CITY WATER SERVIM ON THE CUSTOMER'S ME OF THE METE
TICEBACSFZOWPREVEN?ERMUST RE TESTED BY CERTIFIED TESTER
AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES
DEPARTMENT.
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