Permit Well 1738 Selva marina 2011 0 I ' 1A CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J , , °j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002244 Date 6/24/11
Property Address 1738 SELVA MARINA DR
Application type description WELL PERMIT
Property Zoning RES SF LRG -LOT DISTRICT
Application valuation . . . 0
Application desc
SHALLOW WELL
Owner Contractor
FORSYTH V ALLISON WILLIAMS WELL DRILLING INC
2345 SEMINOLE REACH CT P. O. 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 . 12/21/11
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 will be provided 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.
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.
0 IAA Js i„
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CITY OF ATLANTIC BEACH
WELL PERMIT APPLICATION
Date "-• 7. 2- '//
Owner's Name / / /j•,) rots Address: /73 9 SP%'q Mgf/N'q
Well Address (if different than above):
Well Location on Property (i.e. northeast comer, etc.) A/ ( )
Well Installation Contractor: 4)/0.00/0 f V D /y / y
Contractor License No.: /'f/ 7 Phonej Z 7 030 0 FAX:
Contractor Address:, 0, 0 D - s-.6 7
Check Use of Well: Domestic Irrigation Other
Estimated- Well Depth: /60 " Casing Depth:/ 2 5 ' Screen Interval fronfi r tol6d
Well Diameter: ✓? '' Casing Material ,V
Is address currently connected to the City water system? r' f
�0 /7
Is address currently connected to the City sewer system? Y CS JUN 7
Has a Well Permit been obtained from the City of Jacksonville? iVd p ermrt # Sy , ZOO
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). N
If permit is required, note Permit Number A - and attach a copy.
NOTE: WHEN WELL IS INSTALLED ON YOUR PROPERTY, YOU MUST
INSTALL A REDUCED PRESSURE ZONE TYPE BACKFLOW PREVENTER ON
THE CITY WATER SERVICE, ON THE CUSTOMER'S SIDE OF THE METER.
THE BAC %FLOW FREVENTER MUST BE TESTED BYA CERTIFIED TESTER
AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES
DEPARTMENT.
FI LE COpy
, ; :5 1 -7:1:; - -.4 ; ,, City of Atlantic Beach /
r ( . , Building Department r '� 7 f�
r- 800 S emino Road APPLICATION NUMBER
'.vr Atlantic Beach, Florida 322 33 -544.5 i� ✓�/ ' �
- -...t (To be assigned by the Building Department.)
Phone (904) 2 47 -5826 - Fax ( w i ,��?p //' Z Z y " > E -mail: building - dept @coab.us
City web -site: htt :/ ~ �'
��
P /www.coab.us �� Date routed: 2z- ��
APPLICATION REVIEW
AND ' " ACKING FORM
Property Address: l'731 ��/
/ � � De . artment review re. uired ('n No
Applicant: & lGLQdk— Building
,, j Planning & Zoning = -
Project: a Tree Administrator -
Public Wor --
1 U iliti + e � s,7
=-
Rev>ev fee}$ a
MIMI
Other Agency Review or Permit Required
Review or Receipt
Florida Dept. of Environmental Protection of Permit Verified B Date
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:
(Circle one.) Comments:
❑Denied.
Comments,
BUILDING
PLANNING & ZONING
Reviewed by: Date: f : :
TREE ADMIN. Second Review:
OApproved as revised. ODenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
�I� `L
RF SERVICES Third Review: OApproved as revised. DDenied.
Date:
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