1517 ATLANTIC BCH DR IRRG METER ��• - 4i CITY OF ATLANTIC BEACH
r y PUBLIC UTILITIES
1200. Sandpiper Lane
ATLANTIC BEACH,FL 32233
(904)270-2535 or(904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 10/23/14 Project Address: 1517 Atlantic Beach Dr. —Clubhouse Irrig.
No. of Units: 1 Commercial X Residential Multi-Family
New Water Tap(s) &Meter(s) 1 (meter onlyl_ Meter Size(s) 1.5"
New Irrigation Meter 1.5" Upgrade Existing Meter from to (size)
New Connection to City Sewer N/A
Name: Atlantic Beach Partners/EFS Construction-Doup,Maier
Applicant Address:
City: State: JL Zip:
Phone Number: 759-1395 Cell Number:
Email Address dougmaiercomeast.net Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
New 1.5 potable irrigation meter.
Water System Development Charge $
Sewer System Development Charge $
Water Meter Only $_3.796.00
Water Meter Tap $
Sewer Tap $ (notes)
Cross Connection $ 50.00
Other $
TOTAL $_3.846.00
APPROVED: Donna Kaluzniak 10/23/14
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED