Permit Well 1780 E Park Ter 2012 0'LA` O el
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;. CITY OF ATLANTIC BEACH
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z s) AT 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
, , INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000431
Property Address 1780 E PARK TER Date 4/20/12
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
NEW WELL
Owner Contractor
APP LAWRENCE WILLIAMS WELL DRILLING INC
1780 PARK TERR E P. O. BOX 330567
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 241 -8489
Permit WELL PERMIT
Additional desc .
Permit Fee . . . . 75.00 Plan Check Fee
Issue Date .00
Valuation 0
Expiration Date . . 10/17/12
Special Notes and Comments
Seperate permit required for electrical
connection /wiring to new pumps
A reduced pressure zone backflow preventer must be
installed if irrigation 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.
o ,- City of Atlantic Beach APPLICATION NUMBER
4 Building Department
(To be assigned by the Building Department.)
800 Seminole Road A-;? _ `; , `
V W * Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 Fax (904) 247 -5845
E -mail: building- dept @coab.us Date routed: / Z
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: ise Ait Department review required Yes No
Building
Applicant: i / L ///1A-))1 Planning & Zoning
Tree Administrator
Project: /C i Public Works
0 Utilitie
Public Safety
Fire Services
=� .. is -0 !r ` c .z � 4.; u a _ 7/ ` r k a ° "!£i d.4 ° , •
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: pproved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING
Reviewed by: Date: � 7-la)
THE ADMIN. Second Review: QApproved as revised. ['Denied.
:' • ! ; KS Comments:
PU: LI • 1 1 ss-
C PUBLI SAF r Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. DDenied.
Comments:
Reviewed by: Date:
Revised 07/27/10
CITY OF ATLANTIC BEACH
Date � � �✓ 'l7i WELL PERMIT APPLICATION
Owner's Name /d/ t r / " Address: / 780 At
Well Address (if different than above):
Well Location on Property (i.e. northeast corner, etc.) N6k f il o- / -
Well Installation Contractor: 4a a r
Contractor License No.: 7 Phone: 237 0100 Fax:
Contractor Address: /2, OX ?j d #-. 7 f4v t - /3e-7e--4
Check Use of Well: Domestic Irrigation Other
# of Wells to be installed: / # of Pumps to be installed: /
Estimated- Well Depth: 0" Casing Depth: Z 0 r Screen Interval fromzv to yv
Well Diameter: 7- Casing Material
Is address currently connected to the City water system? �y
Is address currently connected to the City sewer system? 5 '
Has a Well Permit been obtained from the City of Jacksonville ?7,0 y 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). V 0
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.