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Permit Well 330 11th St 2011 � ; !.- 11`j 6 -",, ,,,t? CITY OF ATLANTIC BEACH r- 2, fr � s 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00002500 Date 8/29/11 Property Address 330 11TH ST Application type description WELL PERMIT Property Zoning TO BE UPDATED Application valuation . . . 1000 Application desc Install new shallow well Owner Contractor JOHNSON B ET AL DESTIN WELL AND PUMP, INC 12321 BUCKS HARBOR DRIVE P 0 BOX 413 JACKSONVILLE FL 32225 MACCLENNY FL 32063 (904) 739 -8216 Permit WELL PERMIT Additional desc . Permit Fee . . . 75.00 Plan Check Fee .00 Issue Date . . . 8/26/11 Valuation . . 0 Expiration Date . 2/22/12 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. Of D ate " DS!l TA a M 1, -s -_.lilr City of Atlantic Beach APPLICATION NUMBER r ''','''''\% Budding Department (To be assigned by the Building Department) 800 Seminole Road - '" - 1 Atlantic Beach, Florida 32233 -5445 / Z S \,.: Phone (904) 247 -5826 Fax (904) 247 -5845 _�� / : p li 1> E -mail: building - dept ©coab.us Date routed: City web -site: http: //www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 30 ///-4,S)--- Department review required Yes No r Building A pplicant: ,r ee,7( Pl anning & Zoning Tree i nistra o Project: � / �Pubf��e<, ✓ AiKiio- Uttlities ✓ • Public Safety Fire Services Other Agency Review or Permit Required Review or Receipt Date of Permit Verffled 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: VA . 'proved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING ZONING Reviewed by: (C)) Date: ____VZ.ZZL____ TREE ADMIN. Second Review: approved as revised. ❑Denied. p il4C F 1Af,Q RK g Comments: PUBLIC UTILITIES) PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27110 s Jay � CITY OF ATLANTIC BEACH WELL PERMIT APPLICATION Date j / L — Owner's Name: r 5 h% :To t , VU C V/ Address: 3 3 d r 1 h S Well Address (if different than above): S,MnTht Well Location on Property (i.e. northeast corner, etc.) /U 5 ' Lc A..%r t- / Well Installation Contractor: D r...S i i ry ‘5, // /D,-,///717,5 Contractor License No.: 76),..50 Phone: 23 Z / d(fJ FAX: I / Z Y`/ 3 -)? Ci.5:3' Contractor Address: Pd 3 X / / 3 /?7t? r c n, i'G 3 Zia c 7 Check Use of Well: Domestic Irrigation 4 - ------ Other Estimated- Well Depth: 'l 0 Casing Depth: 0 Screen Interval from 2 to 6 Well Diameter: f y '� Casing Material e✓ - Is address currently connected to the City water system? C S Is address currently connected to the City sewer system? /2 5 Has a Well Permit been obtained from the City of Jacksonville? "' Permit 7 � 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). If permit is required, note Permit Number /V -r I 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.