Permit Well 310 6th St 2012 '��`-►r
`W `= 1 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
±) ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000522 Date 5/24/12
Property Address . . . . . . 310 6TH ST
Application type description WELL PERMIT
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
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Application desc
Install 3 ' deep well
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Owner Contractor
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NELSON JEFFREY & KIMBERLY M WILLIAMS WELL DRILLING INC
480 OCEAN BLVD P. O. BOX 330567
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(9 04) 241-8489
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Permit WELL PERMIT
Additional desc INSTALL 3" DEEP WELL NEW
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 11/20/12
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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
well on the property. Backflow preventer must be tested by
a certified tester and a copy of the results sent to Public
Utilities .
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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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.
City of Atlantic BeachAPPLICATION NUMBER
Building Department / ,, (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-544
54 Phone(904)247-5826 • Fax(90 ) '1-5845 ��ie?
jf E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 31U �` �1 . Department review required Yes No
Building
Applicant: IN `gym S U"e Planning &Zoning
Tree Administrator
`/ Public Works
Project:
Public Safety
Fire Services
:'Dept Signature,,
Review fee N
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
P Of2KS Comments:
L IL I S
PU LIC AFT Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
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CITY OF ATLANTIC BEACH
^WELL PERMIT APPLICATION
Date
Owner's Name:ICIAJ,f �'������`f Address: F
Well Address(if different than above): 310
C
e northeast corner, etc.)
Well Location on Property (i
Well Installation Contractor: �-1/ '' !Y et`j/����
Contractor License No.:
Phone: Y7 OJOrdFax:
Contractor Address: %
Check Use of Well: Domestic Irrigation� Other
# of Wells to be installed: # of Pumps to be installed:
Estimated-Well Depth ' Casing Depth:�3G7 Screen Interval fro ?lt07
Well Diameter: Casing Material
Is address currently connected to the City water system?
Is address currently connected to the City sewer system?
Has a Well Permit been obtained from the City of Jacksonville?
1doPermit#
Does the well require a permit from the St. Johns River Water Management District?
(Not required for wells under 2-inches diameter installed by r sident or wells under 6-
inches diameter if installed by licensed well contractor).
If permit is required, note Permit Number
and attach a copy.
NOTE: WHENA WELL IS INSTALLED ON YOUR PROPERTY,
YOU MUST
INSTALL A REDUCED PRES. ON HE CUSTOMERZONE TYPE CKELOWEREVENTER ON
S SIDE OF THE METER-
THE CITY WATER SERVICE •
THE BACKFLOW PREVENTERM ENT E THE PUBLIC UTILITIES BYA D TESTER
AND A COPY OF THE RESULT
DEPARTMENT.