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1805 Sea Oats Dr Well 2013 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00002753 Date S/31/13 Property Address . . . . . . 1805 SEA OATS DR Application type description WELL PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc NEW WELL ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ JOHNSON BRIAN D & MEGANNE AMERICAN WELL & IRRIGATION INC 1805 SEA OATS DRIVE 49 ARDELLA RD FL 32233 ATLANTIC BEACH FL 32233 ATLANTIC BEACH (904) 249-5400 ---------------------------------------------------------------------------- Permit . . . . . . WELL PERMIT Additional desc . . Plan Check Fee . 00 Permit Fee . . . . 75 . 00 Valuation . . . . 0 Issue Date . . . . Expiration Date . . 11/27/13 --------------------------------------------------------------------- ------ Special Notes and Comments Seperate permit required for electrical connection/wiring to new pumps A reduced pressure zone backflow preventer must be installed on the City water service on the customer' s side of the water meter. Backflow preventer must be tested by a certified tester and a copy of the report 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 CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. RECETVFID City of Atlantic Beach MAY 2 9 Z013 APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 13 - 2 7Y_'� Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us routed: Cityweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: / d02rcJkA_, 047-:S 4&— Department review required Yes No L _ Building Applicant: Planning &Zoning 4nFim�n/ Tree Administrator Project: /vf, Eublia_ZLorks PuWic Utili6e� —P—Mic Safety Fire Services Review fee $ Dept Signature _&L-- Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By 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: Approved. FlDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed bv: Date: TREE ADMIN. Second Review: ElApproved as revised. [��De ied. PU Comments: UBLIC UTILI T Y PUBLIC SA E4 Reviewed by: Date: FIRE SERVICES Third Review: F]Approved as revised. E]Denied. Comments: Reviewed by: Date: Revised 05/14/09 MAY 9 2013 By M111, 0 CITY OF ATLANTIC BEACH WELL PERMIT APPLICATION Date- '�n Owner's Name:-8%A,�,� Je-ta, Address: 66- Well Address(if different than above): Well Location on Property (i.e. northeast corner, etc.) Well Installation Contractor: �Qee- Oil" Contractor License No.: a-7-S-7 Phone: d 37-3 L�5�Fax: ?o t-f- g Ltq j I Contractor Address: tj &IQ Check Use of Well: Domestic_ Irrigation__K Other # of Wells to be installed: # of Pumps to be installed: Estimated- Well Depth: I-A — 0 Casing Depth: 3o Screen Interval from,;b to Well Diameter: Casing Material Is address currently connected to the City water system9 4kg�� V Is address currently connected to the City sewer system? t,,e, cr — Has a Well Pen-nit been obtained from the City of Jacksonville?,& Permit 0 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). VZ 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 BA CKFLOW PREVENTER ON THE CITY KA TER SER VICE, ON THE CUSTOMER IS SIDE OF THE METER. THE BA CKFL 0 W PRE VENTER MUS T BE TES TED B Y A CER TIFIED TES TER AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES DEPARTMENT. A IM R I CA N IvRIE L ft-- & t P.R-rGA T-ION. �tj C 1!1�S-55 4 Back esidence cle, r-lie phone . Adc-MSS 70 1;Jl Job ir-strUct'r,