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Permit New Well 1021 Atlantic Blvd 2012 CITY OF ATLANTIC BEACH tj 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 � INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001400 Date 10/16/12 Property Address . . . . . . 1021 ATLANTIC BLVD Application type description WELL PERMIT Property zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 -------------------------------------------------------------- Application desc NEW WELL --------------------------------------------- Owner Contractor ------------------------ EQUITY ONE ATLANTIC VILLAGE, PARTRIDGE WELL DRILLING CO. 16 NE MIAMI GARDENS DR Q/A:nONAL PARTRIDGE JR. ATTN: TREASURY DEPT 4744 COLLINS RD. MIAMI BEACH FL 33179 JACKSONVILLE FL 32244 (904) 269-1333 ---- Permit WELL PERMIT Additional desc Permit Fee . . . . 75 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/14/13 ---------------------------------------------------------------------------- Special Notes and Comments Seperate permit required for electrical connection/wiring to new pumps Avoid damage to underground water/sewer utilities . Verify vertical and horizontal location of utilities . Hand dig if necessary. If field coordination is needed, call 247-5834 . A reduced pressure zone backflow prevented' 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. `s, •L,, City of Atlantic Beach APPLICATION NUMBER Building Department 2012i (To be assigned by the Build`inDep�jartment) 800 Seminole Road Q Atlantic Beach, Florida 32233-5445 f Phone(904)247-5826 • Fax(904)247-5845 Date routed: 7 �� .ter Jill E-mail: building-dept@coab.us City web-site: hM://www.wab.us APPLICATION REVIEW AND TRACKING FORM Yes No Property Address: �� a� - 91ild De alrtment review re uired J Building Applicant: T,,, Planning&Zoning Tree Administrator Project: _-7) P Pub�cUtiie Public Safety Fire Services Review fee $ Dept Signature Review or Receipt Date Other Agency Review or Permit Required 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: XApproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. P WORkS Comments: LIC UTILITIES Reviewed by: Date: PUBLIC SAFETY FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07127110 r � wI � f C11Y OF ATLANTIC: BEACH WELL PI RVIIT AITLICATION Date__.._.__._._.._ 9126112___._._�__._____�___...___ Owners Name: Equity One Atlantic Village Inc Address: 1600 NE Miami Gardens Dr.,North Miami Bch,FL 33179 Well Address (if different than above): 1021 Atlantic Blvd.,Atlantic Beach,FL 32233 _ Well Location on Property (i.e. northeast corner, ctc.) Northeast( tear of Propertv approc 240ft off Roval Palms Dr.) Well Installation Contractor: Donal M.Partridge Contractor License No.: 1927 Phone: 904-2-69---1-333--i,--FAX:-1-88118-703-31-67 Contractor Address: 4744 Collins Road,Jacksonville FL 32244 Check L'se of Well: Domestic irrigation _ Other F]_. Estimated- Well Depth:----90 Casing I _ lepth: _80__ Screed Interval from NA to NA Well Diameter: 4" Casing M atcrial-___ PVC Is address currently connected to the City water system`' Yes Is address currently connected to thCity sewer system? Yes e Has a Well Permit been obtained from the City of Jacksonville? Yes Permit# Pending Does the well require a permit from the St. Johns Pivcr 'Vater,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). No _.___— __ .__ If permit is required, note Permit Number_NA and attach a copy. NOTE. WHEN WELL IS INSTILLED Off' YOUR PROPERTY, YOU MUST INSTALL A REDUCED PRESSURE ZONE TYPE BACKl+LOW PRI:VF.NTER ON THE CITY WA TER SERVICE, ON THE CUSTOAIER'S SIDE OF THF-METI'R. THE BACKFLOW PREVENT ER MUST BE TES TED B} A CER III IED TESTER AND A COPY OF THE RESULTS SENT TO TNI:PUBLIC UTILITYES DEPARTHEN T.