Sewer Tap Request Sheet 2012 CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH,FL 32233
(904)270-2535 or(904)247-5874
NEW WATER/SEWER TAP REQUEST
Date:S-Z3-t2 Project Address: �7�'d� �l+r /►ey (20 W
No. of Units: Commercial Residential ✓ Multi-Family
New Water Tap(s) & Meter(s) Meter Size(s)
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer
Name:J-1-04E 6L1 C= T` -
Applicant Address:
City: Atlantic Beach State: Zip:
Phone Number: -/Z�Cell Number:
Email Addressor nic�htnav�t'Sr av1.cdr" Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
560ere -A-P 15 Lori r9-
Water System Development Charge $ -rHc W E�t>7" �C6104FOry UAIE
Sewer System Development Charge $ q.0 50.06 OA) DUOC-77-1
Water Meter Only $ Xr
Water Meter Tap $ (notes)
Sewer Tap $
Cross Connection $
Other $
TOTAL
APPROVED:
(UtiliVIDirector r Authorized Signature)
ALL TAP REQUEST MUST APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CANBEASSESSED
White, Debbie
From: Ramsay, Debra
Sent: Thursday, May 24, 2012 8:33 AM
To: White, Debbie; Graham Shirley
Subject: FW: Septic to Sewer
Attachments: Septic to Sewer FAQs.pdf; WS_Tap_Form_56_W_Dutton.pdf
fyi
Thanks,
Debbie
From: Kaluzniak, Donna
Sent: Wednesday, May 23, 2012 4:49 PM
To: dayornightmoves(�Oaol.com
Cc: Ramsay, Debra; Walker, Chris
Subject: Septic to Sewer
Hi Joe,
Here is the information on the Septic to Sewer conversion.
The longest time for financing is 10 years.
As I noted, because the property is not owner occupied, we cannot include the charges on the utility bill—therefore the
interest rate would be 5%.
I'm including the fee sheet,which shows your system development charge (impact fee) of$4,050.
You can finance the total cost, including your plumber's fee.
If you have any other questions, please let me know—thanks, Donna
Donna Kaluzniak
Utility Director
City of Atlantic Beach
902 Assisi Lane
Atlantic Beach, FL 32233
PH: 904-270-2535
FAX: 904-242-3475
dkaluzniak(d)coab.us
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