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Permit Well 1035 Big Pine Key 2012 �S ,lya 1 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD =" ATLANTIC BEACH FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00000984 Date 11/26/12 Property Address . . . . . . 1035 BIG PINE KEY Application type description WELL PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc well ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ CURLEE LINDA A HULIHAN TERRITORY 1035 BIG PINE KEY P.O. BOX 331268 ATLANTIC BEACH FL 322334363 ATLANTIC BEACH FL 32233 (904) 285-8505 ---------------------------------------------------------------------------- Permit WELL PERMIT Additional desc . . Permit Fee . . . . 75 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/25/13 ---------------------------------------------------------------------------- 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 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 CITU OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. . City of Atlantic Beach fir; APPLICATION NUMBER Building Department ' '- (To be assigned by the Building Department.) 800 Seminole Roads q Atlantic Beach, Florida 32233=5445 J�( r f�� Phone(904)247-5826 • Fax 0 01)247--.Ai E-mail: building-deptacoab.us Date routed: 7 3I1 2. City web-site: hftpJkm w.coab.us APPLICATION REVIEW AN[)f TRACKING FORM Property Address: <Q.�� //V ,C,£ Department review required Yes No , / -� Building Applicant: / �f.'7�1 Planning&Zoning Tree Administrator Project: ��`l Public Worics is tilrtie Fire Services 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: pproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: TREE ADMIN. Second Review: []Approved as revised. ❑Denied. "F_U8LIC,WORKS Comments: PUBLIC UTILITI PU C SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27110 f a,T ., CITY OF ATLANTIC BEACH WELL PERMIT APPLICATION Date -7 0 Owner's Name: tT deli-r o;, ddress: 10,2S ,��G e/N'F jtC�[ Well Address(if different than above): Well Location on Property (i.e. northeast corner,etc.) AIA9 _ 7— Well Installation Contractor: -:5 C U Ft H LLk k( ) ?,E3�5-�SC� � Contractor License No.: Phone QO _Fax: M04?D70 Contractor Address: 11 -77 Af [ ci n f-iC 01,/d A+ t t o fi c 0CF L Check Use of Well: Domestic Irrigation V Other 32233 # of Wells to be installed: # of Pumps to be installed: Estimated-Well Depth: 410 Casing Depth: Z-c7 Screen Interval from Zoto v 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? Permit# Does the well require a permit from the St. Johns River Water 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). If permit is required,note Permit Number and attach a copy. NOTE. WHENA WELL IS INSTALLED ON YOUR PROPERTY, YOUMUST INSTALL A REDUCED PRESSURE ZONE TYPE BAC%FLOW PREVENTER ON THE CITY WATER SERVICE, ON THE CUSTOMER'S SIDE OF THE METER THE BACKFLOW PREVENTER MUST BE TESTED BYA CERTIFIED TESTER AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES DEPARTMENT.