Permit Well 2309 Fiddlers Ln 2011 6` � .4 g CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002285 Date 7/18/11
Property Address 2309 FIDDLERS LN
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
new well
Owner Contractor
PESTERFIELD JOHN DAVID WILLIAMS WELL DRILLING INC
2309 FIDDLERS LANE 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 . . 1/14/12
Special Notes and Comments
Seperate permit required for electrical
connection /wiring to new pumps
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.
4
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CITY OF ATLANTIC BEACH
WELL PERMIT APPLICATION
Date 6 ' O /r
Owner's Namefr , / 7'Z fe i /Address: a „0? /r/Q M4 / / ,v ,
Well Address (if different than above):
Well Location on Property (i.e. northeast corner, etc.) 7 .5,c, n'5
Well Installation Contractor: 4///4 0s,c Gi,. / /i. .
Contractor License No.: / 7 Phone: 3 7- D30 FAX:
Contractor Address:t, 0497c. 3 F g ,47 / L-
Check Use of Well: Domestic Irrigation !'..--- Other
c
Estimated- Well Depth: /tQ " Casing Depth;/ S Screen Interval from3o le7
Well Diameter: 3 fr Casing Material /"7 ---
Is address currently connected to the City water system? cte.......5
Is address currently connected to the City sewer system? 7 �y
Has a Well Permit been obtained from the City of Jacksonville? £d Permit #
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). 0
If permit is required, note Permit Number and attach a copy.
NOTE: WHENA 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 PREVENTER MUST BE TESTED BYA CERTIFIED TESTER
AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES
DEPARTMENT.
,,:s n
y1AI;,�, � City of Atlantic Beach` APPLICATION NUMBER
.f ( i1 Building Department ��� p + ` o be assigned by the Building Department.)
800 Seminole Road fi
-_ ; r Atlantic Beach, Florida 32233 -5445 ' 1 1v if p - Z 2 U
Phone (904) 247 -5826 Fax (904) 247 -58 5 `�
o; ;i� %- E -mail: building- dept @coab.us Date routed: -4/1197/
City web -site: htt : / /www.coab.us
tY P
APPLICATION REVIEW AND TRACKING FORM
Property Address: , 4 3O 9 /dd/t6 ` Department review required Yes No
Building
Applicant: t // / ij, s /) Planning & Zoning
Tree Administrator
Project: /OIL (_ Publ' A -
blic Utilitie
ublic Safety
Fire Services
R ev ie w fe T-- ,r ,. 16 j g tur,, � = F ,. � . �,,. . f
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. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date: 71,5 A
TREE ADMIN. Second Review: Approved as revised. ❑Denied.
PUBLIC , a - Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07127/10