1565 BEACH AVE - WATER / SEWER TAP REQUEST 1r ----
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J"\\ CITY OF ATLANTIC BEACH
;' -,G A ) PUBLIC UTILITIES
K-10 - v 1200 Sandpiper Lane
, ATLANTIC BEACH, FL 32233
`I-0131 9T' (904) 270-2535 or (904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 3/13/15 Project Address: 1565 Beach Ave.
No. of Units: 1 Commercial Residential X Multi-Family
New Water Tap(s) & Meter(s) existing—relocating meter Meter Size(s)
New Irrigation Meter Upgrade Existing Meter from 3/4" to 1.5 (size)
New Connection to City Sewer
Name: Matt Carlton
Applicant Address: 1565 Beach Ave.
City: State: FL Zip:
Phone Number: Cell Number: _
Email Address matthew(a,carltonconstruction.net Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
Difference between 34"& 1.5"meter
Water System Development Charge $ 2656
Sewer System Development Charge $
Water Meter Only $ _
Water Meter Tap $ 195`
Sewer Tap $�
Cross Connection $
Other $
TOTAL $ 2,851 (notes)
APPROVED: Donna Kaluzniak 3/13/15
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
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