Permit Septic to Sewer 1441 Begonia 2012 r. .. 'SA CITY OF ATLANTIC BEACH
r s) 800 SEMINOLE ROAD
J - ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
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Application Number 12- 00000013 Date 1/05/12
Property Address 1441 BEGONIA ST
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
septic to sewer conversion
Owner Contractor
BURGESS OWNER
1441 BEGONIA STREET
ATLANTIC BEACH FL 32233
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . .00 Plan Check Fee . . .00
Issue Date . . . 1/05/12 Valuation . . . . 0
Expiration Date . 7/03/12
Other Fees SEWER SDC- SYSTEM DEV CHG 4050.00
WATER CONNECT /METER ONLY 185.00
WATER CROSS CONNECTION 50.00
WATER SDC- SYSTEM DEV CHG 1140.00
Fee summary Charged Paid Credited Due
Permit Fee Total .00 .00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 5425.00 5425.00 .00 .00
Grand Total 5425.00 5425.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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6 CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH, FL 32233
, art
(904) 270 -2535 or (904) 247 -5874
NEW WATER/SEWER TAP REQUEST
Date: 12/16/11 Project Address: 1441 Begonia St. Atlantic Beach, FL 32233
No. of Units: 1 Commercial Residential X Multi- Family
New Water Tap(s) & Meter(s) 1 Meter Size(s) 3/4"
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer 1
Name: John Burgess
Applicant Address: 1441 Begonia St.
City: Atlantic Beach State: FL Zip: 32233
Phone Number: 904 - 613 -7438 Cell Number:
Email Address ecorby61@yahoo.com Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
Water System Development Charge $ 1,140 For septic to sewer conversion,
Sewer System Development Charge $ 4,050 including connection to City water
Water Meter Only $ 185
Water Meter Tap $
Sewer Tap $
Cross Connection $ 50
Other $
TOTAL $ 5,425
(notes)
APPROVED: Donna Kaluzniak
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
CHECK REQUEST
DATE '
12/29/11 y. i s \
VENDOR NO. 2948 _
PAYEE City O
y f Atlantic Beach
ADDRESS 800 Seminole Road
CITY Atlantic Beach P osT
STATE FL
ZIP CODE 32233
ACCOUNT DESCRIPTION ACCOUNT NUMBER PROJECT NO, AMOUNT
Sewer Other Contractual Services 410- 5506 - 535.34 -07 $5,425.00
Subtotal from Page 2
TOTAL $5,425.00
DESCRIPTION OF ITEM OR SERVICE:
Sewer SDC Fee of $4,050, Water SDC fee of $1,140, meter charge of $185 and Cross -Conn. Fee of $50 for 1441 Begonia
St. RE No. 171082 -0500.
SPECIAL INSTRUCTIONS:
Please forward check to the Building Department for processing
To expedite processing, please attach adequate documentation to support payment.
ADDITIONAL APPROVALS ONLY REQUIRED
WHEN CHECK REQUEST IS OVER $500
4 f � /!( d / E s � REQUESTED BY / DATE DEPT H / DATE FINA C
DIR tIIA'fE Cr MGR /DATE
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O: \Utility\SEPTIC TO SEWER CONVERSIONS\[1441 Begonia check request.xls]Form Pg. 1