1285 CAMELIA ST - SEWER HOOK UP �5 f CITY OF ATLANTIC BEACH
_ si 800 SEMINOLE ROAD
J �r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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JSi1>r
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-RAAR-1877
Job Type: RESIDENTIAL ALTERATION
Description: septic to sewer tap fees for processing fee only
Estimated Value:
Issue Date: 8/18/2016
Expiration Date: 2/14/2017
PROPERTY ADDRESS:
Address: 1285 CAMELIA ST
RE Number: 171051-0050
PROPERTY OWNER:
Name: Management Systems, Mandarin
Address: 820 MCCOLLUM CIR
PERMIT INFORMATION:
FEES:
SEWER SDC-SYSTEM DEV $4,050.00
CHG
WATER CROSS CONNECTION $50.00
Total Payments: $4,100.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
"�_ _ r PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH,FL 32233
0219'''
'i}>r (904)270-2535 or(904)247-5874
NEW WATER/SEWER TAP REQUEST
Date: g/(7/0°/‘ Project Address: /243--- .
No. of Units: Commercial ✓ Residential Multi-Family
New Water Tap(s)& Meter(s) Meter Size(s)
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer /Z
Name: 414 /Llet1t i s 4c. (Ran5.c.AOe'
Applicant.Add Lon ea W
City: ( State: Wit- Zip: 3 272.1'
Phone Number: 90 Cell Number: 9d}L_ 36 2— S'a'o/ -7.r
Email Address Fax:
Signature at-ts,e4-<-Wiatlik(
(Applicant)
CITY STAFF USE ONLY
Application#
Water System Development Charge $
Sewer System Development Charge $ y are. (�')
Water Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $ 50, c.c.
Other $
(notes)
TOTAL $ �� ICO.CO
APPROVED:
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED
CC. — i51 t% I. ►b