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Permit Well 2059 Selva marina Dr 2011 . ` ' s CITY OF ATLANTIC BEACH r 0 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 ` yCIil9f' Application Number . . 11- 00002303 Date 7/25/11 Property Address 2059 SELVA MARINA DR Application type description WELL PERMIT Property Zoning TO BE UPDATED Application valuation . . . 0 Application desc new well Owner Contractor COLEY, ALVIN HULIHAN TERRITORY P.O.BOX 50617 P.O. BOX 331268 JAX BEACH FL 32240 ATLANTIC BEACH FL 32233 (904) 285 -8505 Permit WELL PERMIT Additional desc . Permit Fee . . . 75.00 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date . . 1/21/12 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. RECE1 !...\ City of Atlantic Beach APPLICATION NUMBER Atlantic BeachFlorida 32233-5445 ,, JUL 0 7 2011 i , (To be assigned by the Building Department) ,-- '::?, 800 Seminole Road , j Phone (904) 247-5826 - Fax (904) E-mail: building-dept@coab.us j Date routed: /MI 4 City web http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: (6' 6 ,Sdv A..)r Department review required Yes No Building Applicant: th // A x-7) 7iLe/7/71 Planning & Zoning Tree Administrator Project: s. " -- 27. /A) bt.). / / Public Works . ublic Utillires: Public Safety Fire Services 061VieWteecti..#-tr•ffiggi'• ,it Aatairiffe~"- - r.t , T,,., , :4 Review or Receipt Other Agency Review or Permit Required 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. ODenied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: Date: . 7-7. - / ( TREE ADMIN. Second Review: DApproved as revised. ['Denied. a Comments: 0 BLIC UTILITIES PUBLIC AFE Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. DDenied. Comments: Reviewed by: Date: Revised 07/27/10 sr jJY . , , xis t :f . , )..10 - Aortu,J)' CITY OF ATLANTIC BEACH WELL PERMIT APPLICATION Date 7- (0-II Owner's Name: 0"'1 /ids ache Address: Z0 5 /(/ /��r, h. (...)./ Well Address (if different than above): A ✓n 2_ Well Location on Property (i.e. northeast corner, etc.) S©ci Ii'l ("- � i" 4, & 1'G h6k 2 Well Installation Contractor: / /I% M' 1i9✓r -�2 c Contractor License No.: 7 3 6 5. Phone: A kra S a-CFAx ?o Z Z 3e Contractor Address: (( 7 ,4i¼, 7 e..._ /1/ Check Use of Well: Domestic Irrigation V Other / Estimated- Well Depth: } C as i ng Depth: /S Screen Interval from 2vto 3 0 Well Diameter: ) ` Casing Material PVC.- - ef Is address currently connected to the City water system? Is address currently connected to the City sewer system? - �$ Has a Well Permit been obtained from the City of Jacksonville? Permit # u fki‘?°d- Does the well require a permit from the St. Johns River Water Management District? (Not required for wells under 2- inches diameter installed by residen,or wells under 6- inches diameter if installed by licensed well contractor). 4/' J 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 BACKFLOW PREVENTER MUST BE TESTED BYA CERTIFIED TESTER AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES DEPARTMENT.