Permit Well 1938 Beachside Ct 2011 Ja ,v)
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
` �� "4 -" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002508 Date 9/07/11
Property Address 1938 BEACHSIDE CT
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
NEW WELL
Owner Contractor
BARKER HULIHAN TERRITORY
1938 BEACHSIDE COURT P.O. BOX 331268
ATLANTIC BEACH FL 32233 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 . . 3/05/12
Special Notes and Comments
Seperate permit required for electrical
connection /wiring to new pumps
A reduced pressure zone backflow preventer must be
installed on customer side of City water service if
irrigatin 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...: `r:r City of Atlantic Beach APPLICATION NUMBER
use t Building Department �,
, 800 Seminole Road � 9 ' (To be assigned by the Building Department.)
� Atlantic Beach, Florida 32233 -5445 Vy p-� - J
Phone (904) 247 -5826 Fax (904) 2V-5845411i: 1 8 p�� a-! g� �r
. tt E -mail: building- dept @coab.us 2 Date routed: a
City web -site: http: / /www.coab.us �
APPLICATION REVIEW AND CKING FORM
t
Property Address: 0 - Department review required Yes No
• Building
Applicant: Planning & Zoning
Tree Administrator
Project: e„ Publi0il1/rks
(FrUblic Utilities /` ' X
Public Safety
Fire Services
S
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 Cr Date:
'//
TREE • •
Second Review: Approved as revised. DDenied.
r' = - 1?VORKS omments:
O Alp*
PUBLIC SA ETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
N -
11
'4 v
r
CITY OF ATLANTIC BEACH
WELL PERMIT APPLICATION
Date ( a -- l
Owner's Name: ,1- c. Address: \ 9 ,, �, S c �� C b -
Well Address (if different than above):
Well Location on Property (i.e. northeast comer, etc.) t�
Well Installation Contractor: �Jc�c, - `c �• c��
Contractor License No.: Phone: `2 SX 5li �� FAX: 2 7 v Z Z -� u
Contractor Address: l 1 1 �{- 1 344 I5
Check Use of Well: Domestic Irrigation, Other
Estimated- Well Depth: -)0 Casing Depth: Screen Interval from to
Well Diameter: Casing Material
Is address currently connected to the City water system? '1 Q .,
Is address currently connected to the City sewer system? .P�
Has a Well Permit been obtained from the City of Jacksonville? -` 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 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.