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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 ---------------------------------------------------------------------------- Application desc Install 3 ' deep well ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ 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 ---------------------------------------------------------------------------- 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 ---------------------------------------------------------------------------- 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 . ---------------------------------------------------------------------------- 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. 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 r J � J ft cyr 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.