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Permit Well 1844 Sea Oats Dr 2013 f,f!rZ.r�1;r CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001825 Date 2/14/13 Property Address . . . . . . 1844 SEA OATS DR Application type description WELL PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc new well ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ LAGOY, EDWARD HULIHAN TERRITORY 1844 SEA OATS DRIVE P.O. BOX 331268 ATLANTIC BEACH FL 32233 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 . . 8/13/13 ---------------------------------------------------------------------------- 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 . ---------------------------------------------------------------------------- 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. City of Atlantic Beach — Building Department APPLICATION NUMBER 8tm Seminole Road �_ (To be assigned by the Bt ;ft Department) ..� Atlantic Beach, Florida 32233-5445 Z Phone(904)247-58'26 • Fax(904)247-5845 r3F31 J*' E-mail: building-deptGcoab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property p dYAddress: y ��7 ��4i l�a%5 �-- Department review re uired Yes No Building Applicant: �/ �� Planning&Zoning /� 1 Tree Administrator Project: /iy� L Public Works W ublic Utilities. Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date Florida Dept. of Environmental Protection Florida Dept. of Transportation S't 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: ❑Approved as revised. Denied. P Comments: UTILITIES PUBLIC Reviewed by: Date: FIRE SERVICES Third Review: ®Approved as revised. ❑Denied. Comments: Reviewed by:_ Date: Revised 07127/10 CITY OF ATLANTIC BEACH WELL PERMIT APPLICATION Date Z'' l —C Z-- Owner's Name: L%v Address: 49 Well Address (if different than above): Well Location on Property (i.e. northeast corner, etc.) tG Lam•— G� Well Installation Contractor: 4, Contractor License No.: 73 Phone: Z 9s-4FJt0f-'rax:ax: 2 Zo ZZ a Contractor Address: 11 7 l�lzl- Check Use of Well: Domestic Irrigation // Other # of Wells to be installed: l # of Pumps to be installed: Estimated- Well Depth: Casing Depth: Screen Interval from/Qto f z,6 v. r-- 1©, Well Diameter: L %y Casing Material ri- C- 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# zol Z- lZ SSS 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). It/ o If permit is required, note Permit Number and attach a copy. NOTE: WHENA WELL IS INSTALLED ON YOUR PROPERTY, YOU MUST INSTALL A REDUCED PRESSURE ZONE TYPE BACKFLOW PRE VENTER ON THE CITY WATER SERVICE, ON THE CUSTOMER'S SIDE OF THE METER. THE BACKFLOW PRE VENTER MUST BE TESTED BYA CERTIFIED TESTER AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES DEPARTMENT.