PU Meter for Well 1464 Camelia 2011 C J� 4-4 x � CITY OF ATLANTIC BEACH
+ -' ) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number . . . . . 11- 00003008 Date 12/15/11
Property Address 1464 CAMELIA ST
Application type description UTILITY CONNECTION
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
PURCHASE OF METER FOR WELL
Owner Contractor
WEST CHARLES W OWNER
1464 CAMELIA STREET
ATLANTIC BEACH FL 32233
Permit UTILITIES PERMIT
Additional desc . FEE FOR METER FOR WELL
Permit Fee . . . .00 Plan Check Fee . . .00
Issue Date . . . 12/15/11 Valuation . . . . 0
Expiration Date . 12/15/11
Special Notes and Comments
PAYMENT OF 90.00 FOR A METER TO CONNECT
TO A WELL FOR SEWER BILLING PURPOSES
Other Fees WATER CONNECT /METER ONLY 90.00
Fee summary Charged Paid Credited Due
Permit Fee Total .00 .00 .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.
CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH, FL 32233
Il (904) 270 -2535 or (904) 247 -5874
NEW WATER/SEWER TAP REQUEST
Date: 12/15/11 Project Address: 1464 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