1209 W Plaza Rd 2013 well CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002820 Date 6/28/13
Property Address . . . . . . 1209 W PLAZA
Application type description WELL PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . .
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Application desc -------------------------------
160 ' deep well
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Owner Contractor
------------------------ ------------------------
VONN BRIAN S & CHERYL F WILLIAMS WELL DRILLING INC
8165 CORALBERRY LANE P. 0. BOX 330567
JACKSONVILLE FL 32244 ATLANTIC BEACH FL 32233
(904) 241-8489
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Permit . . . . . . WELL PERMIT
Additional desc . .
Permit Fee . . . . 79 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . . 00
Expiration Date . . 12/25/13 0
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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
Building Department APPLICATION NUMBER
800 Seminole Road (To be assigned by the Building Department.)
tlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
r 1 E-mail: building-dept@coab.us t
Date routed:
City web-site: http://www.coab.us [D:a F:eroutegd (0
APPLICATION REVIEW AND TRACKING FORM
Property Address: C� Department review required Yes No
Building
Applicant:
Aff§ Planning &Zoning
Trep 8,4 ' ' t
Project: awils rator
Public 11 ies
y
Fire Services
Review fee $ Dept Signatu e
Other Agency Review or Permit Required Review or Receipt
Florida Dept. of Permit Verifie By Date
Florida Dept.ot I ransportation
St.Johns River water Management District
Army Corps of Engineers
Division of Hotels and Restaurant s
s and Tobacco
ther:
APPLICATION STATUS
proved.
Reviewing Department First Review: XAp DDenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:
Date:
TREE ADMIN. Second Review: E]Approved as revised. E]Denied.
PUBLIC WORKS Comments:
<fP:U:BL:IC=UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. DIDenied.
Comments:
Reviewed by: Date:
Revised 05114/09
-2-�52-0
JUN 06 2013
By
CITY OF ATLANTIC 13EACH
Date_,� ERMIT APPLICATION
Owner's NameAt/.1w -�' V01vA1Address:_y1,61, 5-
Well Address (if different than above)
Well Location On Property(i.e. northeast corner, etc.)
Well Installation contractor
Contractor License No.:_ —.Phone: 9-�;7-5�!�OFax:
Contractor Address:-I�. /1--3 0 �� ?, -:�7-o Z
Check Use Of Well: Domestic—/—""' Irrigation_ Other—
# Of Wells to be installed: /— # Of PUMPS to be installed:
Estimated- Well Depth /Casing DepthZZ,.,�11 Screen Interval from/
Well Diameter: 161 Casing Material—g–,64---
Is address currently connected to the City water system?– oellc:5>
Is address currently connected to the City sewer system?_ Al,,2
Has a Well Permit been obtained from the City of Jacksonville? /JO7–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). 0��P/q
If permit is required, note Permit Number and attach a copy.
NOTE-' WHENA WELL IS INSTALL
LNSTALL A
.......................... EDON YOUR PJ?OPERTY, YOUMUST
RE' RUCED PRESSURE ZQN, E TYPE
................ ..........1, 11 'SER VIcE, ON BA CKFL 0 W PRE VENTE ON
R
PR E VETN i............11:..............`...............................I...........'�"77..... 7- A SIDE 0F2HE METER
11�0, 17 1 CK 119 �US�O�WN�
ER
AND A Copy OF THERES IDBYA
TIFIED TESTER
DEPARTMENT UL IS SENT TO THE PUBLIC UTILITIES