Permit Well 353 7th St 2012 CITY OF ATLANTIC BEACH
1 800 SEMINOLE ROAD
J A " ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001785 Date 12/26/12
Property Address . . . . . . 353 7TH ST
Application type description WELL PERMIT
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
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Application desc
new well
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Owner Contractor
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MARTINEZ JUAN CARLOS & WECHTER WILLIAMS WELL DRILLING INC
MARY ELLEN P. O. BOX 330567
303 9TH STREET ATLANTIC BEACH FL 32233
ATLANTIC BEACH FL 32233 (904) 241-8489
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Permit . . . . . . WELL PERMIT
Additional desc . . 1 WELL 1 PUMP FOR IRRIGATION
Permit Fee . . . . 79 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/24/13
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Special Notes and Comments
Seperate permit required for electrical
connection/wiring to new pumps
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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 79 . 00 79 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 83 . 00 83 . 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
APPLICATIONL
Building Department ( � To be as
800 Seminole Road ( signed by the t)
44 Atlantic Beach, Florida 32233-5415 p ) �Z
Phone(904)247-5626 - Fax(904)247 5845 %}
Vilill ` E-mail: building-deptQcoab_us !1 Date routed: /2-
CRY web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
7171 S7-
Property Address: MPPII
Tn-g
ent review re uired Yes No
Applicant: ��/ Cf-yy� S �� Zoning
Project: �G inistrator
Project: rks
litieses
Review fee $ nl� Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
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
IReviewing Department First Review: Approved.
❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING
Reviewed by: Date:_
TREE ADMIN, Second Review:
OApproved as revised. ❑Denied.
WO S Comments:
PU LIC UTIL T
-72,ET
P ELIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 0712T110
CITY OF ATLANTIC BEACH
WELL PERMIT APPLICATION
Date
Owner's Name:C &4A/ - 6AIIfZ &,yeIAddress: 3 04f j`l,
Well Address (if different than above): 3 .s 3 ?f"'�
Well Location on Property (i.e. northeast corner, etc.) Al- A�E
Well Installation Contractor:—/—a-4,/' 41 G✓e 1114• ,sf
Contractor License No.: l e7ll 7 Phone:Z3-7 aYva Fax:
Contractor Address: /
Check Use of Well: Domestic Irrigation !' Other
# of Wells to be installed: / _ # of Pumps to be installed:
Estimated- Well Depth: Casing Depth:/2- $ Screen Interval fron-l�to,,6r
Well Diameter: 3 Casing Material
Is address currently connected to the City water system? S
Is address currently connected to the City sewer system? y s
Has a Well Permit been obtained from the City of Jacksonville? -v - 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). At 4>
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 BACKFLOW 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.