92 W 3rd St septic to sewer CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000870 Date 11/15/12
Property Address . . . . . . 92 W 3RD ST
Application type description SYSTEM DEVELOPMENT CHARGE RESIDENTIAL (S
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
SEPTIC TO SEWER CONVERSION
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Owner Contractor
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JORGENSEN CHRISTIAN E.J. OWNER
92 W 3RD ST
ATLANTIC BEACH FL 32233
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Permit . . . . . . ADV PMT-SEWER IMPACT FEE
Additional desc . . SEPTIC TO SEWER CONNECTION
Permit Fee . . . . . 00 Plan Check Fee . 00
Issue Date . . . . 11/15/12 Valuation . . . . 0
Expiration Date . . 11/15/12
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Other Fees . . . . . . . . . SEWER SDC-SYSTEM DEV CHG 4050 . 00
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Fee summary Charged Paid Credited Due
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Permit Fee Total . 00 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4050 . 00 4050 . 00 . 00 . 00
Grand Total 4050 . 00 4050 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH, FLORIDA
VOLUNTARY ASSESSMENT AGREEMENT
PROPERTY DESCRIPTION:
OWNER: Christian E. J. Jorgensen
92 W. 3rd St.
Atlantic Beach, Florida 32233
PROPERTY ADDRESS: 92 W. 3" St.
RE#: 170832-0040
LEGAL DESCRIPTION: 18-34 17-2S-29E
Sec H Atlantic Beach
Lot 4 BLK 80
This document shall serve as an extended payment agreement between you and the City of
Atlantic Beach, Florida for the above listed total amount and for which said amount will be filed
as a lien with the Court of the Circuit Court for Duval County, Florida until the entire balance is
paid.
CHARGES: System Development Charge$4,050.00
Contractor 3,150.00
Filing Fees 35.50
TOTAL CHARGES FINANCED: $7,235.50
TOTAL INTEREST OVER LOAN TERM: $1,555.21
TOTAL AMOUNT OF AGREEMENT/LIEN: $8,790.71
TERMS: Number of Monthly Paymcnts 120
Due Date Due monthly with your utility bill
Billing Included on utility bill
Late Charges 10%
Failure to pay all charges will result in the water services being cut-off.
Payment Amount $73.26 per month
Total Interest over term of loan $1,555.21
Interest Rate 4.00%
LIEN: A lien.in the amount of the TOTAL AGREEMENT above shall be executed and
recorded against the above referenced properties. The owner hereby agrees to pay all
recording fees and costs involved with the execution of the lien. Upon payment being
made in full, the lien shall be released of record.
SCANNED