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
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Application desc
well
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Owner Contractor
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CURLEE LINDA A HULIHAN TERRITORY
1035 BIG PINE KEY P.O. BOX 331268
ATLANTIC BEACH FL 322334363 ATLANTIC BEACH FL 32233
(904) 285-8505
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Permit WELL PERMIT
Additional desc . .
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/25/13
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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
private 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 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.