2470 MAYPORT RD H20/SEWER FEES -
<� ATLANTIC BEACH
'} ? PERMIT RECEIPT
PERMIT DESCRIPTION: FAMILY DOLLAR CONNECT TO H20/SEWER
PERMIT NUMBER: 15-PLBG-657
ADDRESS: 2470 MAYPORT RD
OWNER:
FEES DUE:
SEWER SDC-SYSTEM DEV CHG $4,050.00
WATER CROSS CONNECTION $50.00
WATER SDC-SYSTEM DEV CHG $2,280.00
WATER CONNECT/TAP &METER $370.00
Totals: $6,750.00
.11,
CITY OF ATLANTIC BEACH
\ 1
s PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH, FL 32233
-119 (904) 270-2535 or(904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: S" Project Address: 241 -70 4414V f4Z_ "✓
No. of Units: Commercial /"Residential Multi-Family
New Water Tap(s) &Meter(s)
Meter Size(s) `3
New Irrigation Meter ✓/ Upgrade Existing Meter from to (size)
New Reclaimed Water Meter Size New Connection to City Sewer ✓
Name: f a-
Applicant Address:
City: State: Zip
Phone Number: Cell Number:
Email Address Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
Water System Development Charge $ Z-. 2$O, 5 PC Gee ' s
Sewer System Development Charge $ - 005-0 ,
v 0 U ` " Sd c � � err �-
Mr
Water Meter Only $ 370 - dU Me-TE2 rE1' 6rZZ- Er&Y.�
Reclaimed Meter Only $ f v'- S---1e
Water Meter Tap $ _ _ (notes)
Sewer Tap $ p io(e G�-
Cross Connection $ t7X)
Other $
TOTAL $ • o �� —y
APPROVED: Kayle Moore, PE
(Deputy PW Director or Authorized Signature) ALL TAP REQUEST MUST BE
APPROVED BY UTLITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED