SDC - CDBG 1496 Camelia 2012 ?S y r
J
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' CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
J Z ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000236 Date 2/29/12
Property Address 1496 CAMELIA ST
Application type description SYSTEM DEVELOPMENT CHARGE RESIDENTIAL (S
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
SEPTIC TO SEWER CHARGES
Owner Contractor
CHARLES JESSE CREGAR OWNER
1496 CAMELIA STREET
ATLANTIC BEACH FL 32233
Permit UTILITIES PERMIT
Additional desc .
Permit Fee . . . .00 Plan Check Fee . . .00
Issue Date . . . 2/29/12 Valuation . . . . 0
Expiration Date . 2/29/12
Other Fees SEWER SDC- SYSTEM DEV CHG 4050.00
WATER CONNECT /TAP & METER 800.00
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 6040.00 6040.00 .00 .00
Grand Total 6040.00 6040.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
REORDER 905 • U.S. PATENT NO. 5538290, 5575508, 5641183, 5785353, 5984364, 60300
1 k ✓
`'. CITY OF ATLANTIC BEACH
1 .v 800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233 -4445
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD NO. 104143
ATLANTIC BEACH. FLORIDA 32233 -4445
INVOICE INVOICE PIUR( PROJECT
NI!MBER DATE ACCOU
ORDER NO. NIIM1IIIl %R NI AMER
AMOUN
RE #171078 0100 02/27/2012 110- 5506 - 535.83 -00 6,040.00
GROSS RETAINAGE DISCOUNT
NET
$ * * * ** *6,040.00
$ * * * ** *6,040.00
CHECK REQUEST
2 2
DATE
02/27/12 '-
- �
is1
VENDOR NO. 4 ,.
2948
PAYEE City of Atlantic Beach
DIn
ADDRESS 800 Seminole Road
POSTED
CITY Atlantic Beach
STATE FL
ZIP CODE 32233
ACCOUNT DESCRIPTION ACCOUNT NUMBER
PROJECT NO. AMOUNT
Sewer Other Contractual Services 110 -5506- 535.83 -00
$6,040.00
Subtotal from Page 2
TOTAL $6,040.00
DESCRIPTION OF ITEM OR SERVICE:
Fees for 1496 Camelia St., RE No. 171078 -0100. (CDBG Septic to Sewer, includes connection to City water): Sewer impact
fee = $4,050. Water impact fee = $1,140. Water tap &meter = $800. Cross- connection fee = $50.
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
z 27 WHEN CHECK REQUEST IS OVER $500
2 /Z.
REQUESTED BY /DATE DEPT HEAD / DATE FINANCE DI DATE 7,T MGR / DATE
O: \Finance \finance forms \Check & ACH Request Forms \[sewer impact fee check request.xls]Form Pg. 1