Permit 1760 Live Oak Ln (vault) FIT $10.nO
A-PPLICATICN FOR �01 PERMIT
CnY OF ATWUIC 2EACH
PROPEFaY (X44ER
___Pay Phone
Address c A-
APPLIGqU, IF MM nM %AER
Name: Z Day
AA
Address., a-
zi-
ell
JOB
Address or Location:
Legal Description:
Is well to be used for drinking purposes?
Any person, individual, corporation or other entity receiving a perniLt as
provided in Section 22-40 of the Atlantic Beach Code, and who plans to use
water from the pern-dtted well for drinking purposes, mist first obtain a
bacteriological test report from.the State of Florida Health Depart � t,
ftnrdshing a certified copy thereof to the building department of the City of
Atlantic Beach. A certificate of occupancy VAll not be issued until said
report is on file with the building department.
Department Notes:
�Y
I/agree o ccwly with regulations stated herein:
77
gmture 'C' &/z/ Date
P U
S�44
DEPARTMENT OF BUILDING
CITY OF ATLANTIC'SEACH
PERRIT INFORMATION ---- ------- LOCATION INFORMATION
Pperm4t Nuj�bex, Addres'is 11'60 LIVE OAK, LANE
Permit, Type:RELL ATLANTIC SEACH, FLORIDA "32231
Class of Work-.NEW LWAL DESCRIPTION- ------- --
Constr. Type,4WOOD FRAME Slock., 'Lot,
Twp, 0 ,
Proposecl Use* SINGLE FAMILY 0
section: 0 subd* Rog:
Dwellings ., 01 Subdivision:SELVA MARINA ,
Est. Valuet 0.00
Improv . _CO3t1 *. 0 .*
Total treq's., 10 .00
Amount ,!,�,, 10 .00
Da to
Wotk 04 FOR IRRIGATION PURPOSES
APPLICATION FEES,
----------
ion
;;91T 101.00
AAd,
g#
FLORIDA: 32?"$
o�
eem ect
411
1" ZRIT
A,
FORM
c OR, AT I q*
Name: L. ,"W I
AOX11--fl, 67
ATLANTI CH
Lic
04
T� 1 7 1'11,1.��,
0.,
NOTES:,
BE REQUESTED AT LEAST,.24 HOURS PRIOR TO INSPECTION
NOTICE-INSPECTIONS MUST
BUILDING MATERIAL,RUBBISH AND.DEBPIS FR OM THIS WORK MUST NOTBE PLACEO,IN PUBLIC SPACE,,AND MUST BE
'CLEARED U PI AND HAULED AWAY BY EITHER,CONTRACTOR OR OWNER,
"FAILURE TO COMPLY: WITH THEVECHANICS. L115N W' CANASSULT IN
S1.0
THE' PROPERTY OWNER PAYING TWICE, 0O'R,8U1Lbt?fG:IM EMENT
ISSUED ACCORDING TO APPROVED,PLANS WHICH ARE PARTOF THISPERMIT AND SUBJECT TO REVOCATION FOR
�' ;,AOLATJON OF,APPLICABLE PROVISIONS OF,LAW.
PARTMENT
ATLANTICAEACH BUILDING D
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