740 PARADISE LN - WATER / SEWER '° City of Atlantic Beach
o r .1.---d j PUBLIC UTILITIES DEPARTMENT
:-',:-,L 1200 Sandpiper Lane
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Atlantic Beach, FL 32233
• ts. ° (904)247-5834
NEW WATER/SEWER TAP REQUEST
Date / / ` 2 7—/ 7 Project Address 7 e/O PA-re.9-v i S C (o÷-xj &---
Number
Number of Units f Commercial Residential ✓ Multi-Family
3
.,New Water Tap(s) & Meter(s) Meter Size(s) ,'q
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclaim Water Meter Size New Connection to City Sewer ✓
Applicant Name
•
Applicant Address
City State Zip
Phone Cell
Email
Applicant Signature
CITY STAFF USE ONLY
Application it IZE5/7 — D / y CI
Water System Development Charge $ / 1i-lo , 0 D
Sewer System Development Charge $� V So , vz)
Water Meter Only $ 18 Sr C)U
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $ 50, C.X)
Other $
TOTAL $ 5' 4/S-0, 00 (Notes)
APPROVED Kayle Moore, P.E. G1X--AvN, Date 2, 1
Public Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED