1837 OCEAN GROVE DR.PU FEES CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH,FL 32233
(904)270-2535 or(904)247-5874
NEW WATER/SEWER TAP REQUEST
Date: /-7Z—/Project Address: AR57 1 yAl J;ggll
No. of Units: _ I Commercial Residential Multi-Family
New Water Tap(s)&Meter(s) — Meter Size(s)
New Irrigation Meter Upgrade E•x'isstin_g Meter from to (size)
N �v Connection to City Sewer i Iv V—
Name:
Applicant Address:
City: Atlantic Beach State: Zip:
Phone Number: Cell Number:
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application# 1 S—,SF/�'_ l(Q/
Water System Development Charge $ OA/04ea "
Sewer System Development Charge $ n,, rh� f-V* L ?W~40Water Meter Only $ Y'�`^
Water Meter Tap $ 2 (notes) /1 v
Sewer Tap $
Cross Connection $
Other $
TOTAL $
APPROVED: ZV",—
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED