1661 ATLANTIC BEACH DR - NEW WATER/SEWER TAP REQUEST CITY OF ATLANTIC BEACH
n PUBLIC UTILITIES
1200 Sandpiper Lane
ATLANTIC BEACH,FL 32233
(904)270-2535 or(904)247-5874
NEW WATER/SEWER TAP REQUEST?
Dau: 7- 21--/G Project Address: 1661 4rlgLna p"
No. of Units: Commercial Residential Ll"� Malt3-Family
New Water Tap(s)&Meter(s) Meter Size(s) Aq "
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclaim Water Meter V Size 34 New Connection to City Sewer ✓
Name:
Applicant Address: a
City: State: Trp
Phone Number: Cell Number:
Email Address Fax:
Signature:
(Appluxud)
CITY STAFF USE ONLY
Application# AL S` - /G'//
Water System Development Charge $ / / v. OO✓
Sewer System Development Charge $ as-0.t:�
Water Meter Only $ d
Reclaim Meter Only $�WA-IL
Water Meter Tap $ (notes)
Sewer Tap $
Cross Connection $O
Other $
TOTAL $ /O. Cc
APPROVED: Kavle Moore.PE
(Deputy PWDirector or AuthorizedSigwnve)
ALL TAP REQUEST MUST BE APPROVED By UTLITIES DEPARTMENT BEFORE FEES
CANBEASSESSED