PU Meter for Well 1432 Camelia 2011 t! A/V
CITY OF ATLANTIC BEACH
! 'r 800 SEMINOLE ROAD
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x ATLANTIC BEACH, FL 32233
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INSPECTION PHONE LINE 247 -5814
Oil 9
Application Number . 11- 00003009
Property Address Date 12/15/11
p 1432 CAMELIA ST
Application type description UTILITY CONNECTION
Property Zoning
Application valuation • TO BE UPDATED 0
Application desc
INSTALL METER ON WELL FOR SEWER BILLING PURPOSES
Owner
Contractor
CAMELLIA STREET PROPERTIES LLC
POST OFFICE BOX 28130 OWNER
JACKSONVILLE FL 32226
Permit UTILITIES PERMIT
Additional desc . METER FOR WELL
Permit Fee . . . .00 Plan Check Fee
Issue Date 12/15/11 00
Expiration Date . • Valuation 0
12/15/11
Special Notes and Comments
PAYMENT OF 90.00 FOR WATER METER TO BE
INSTALLED ON EXISTING WELL FOR SEWER
BILLING PURPOSES
Other Fees WATER CONNECT /METER ONLY
90.00
Fee summary Charged Paid
Credited Due
Permit Fee Total .00 .00
Plan Check Total .00 .00 .00
. . .00
Other Fee Total
90.00 90.00 .00 .00
Grand Total 90.00 90.00
.00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
at CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH, FL 32233
OJ (904) 270 -2535 or (904) 247 -5874
NEW WATER/SEWER TAP REQUEST
Date: 12/15/11 Project Address: 1432 Camelia St.
No. of Units: 1 Commercial Residential X Multi- Family
New Water Tap(s) & Meter(s) 1 (Installing meter on well) Meter Size(s) 3 /4"
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer
Name: Judy Weiss
Applicant Address:
City: State: Zip:
Phone Number: Cell Number: 502 -6177
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
Connected to sewer, want to install
Water System Development Charge $_ meter on well for billing purposes.
Sewer System Development Charge $ Cost of meter only (no installation — to
Water Meter Only $ be installed by customer's plumber).
Water Meter Tap $
Sewer Tap $ Ms. Weiss would like to pick up the
Cross Connection $ meter at City Hall.
Other (meter for well) $ $90
TOTAL $ $90
APPROVED: Donna Kaluzniak
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED