2265 Sandy Bay Ln UTIL18-0045 JUN 2 9 2018 City of Atlantic Beach
�i PUBLIC UTILITIES DEPARTMENT
BY:
~ '1 1200 Sandpiper Lane
• Atlantic Beach,FL 32233
••{+t� i��r (904)247-5834
NEW WATER/SEWER TAP REQUEST
. � `� _ Ln,,,
Date fp'7Q,/y Project Address e29LO6 ---nr u T7L1�1 L 1
Number of Units Commercial_ Residential y Multi-Family
New Water Taps &Meters r1
pO O� Meter Sizes)
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclalm Water Meter_ A .,Size New Connection to City Sewer_
Applicant Name bJ�� !•rrt.M-.rTt C. j3Ott.-Q Flt-S yIt-ic
Applicant Address 158751 HWwe. Teap 4cg SVlift 206
City _ A'C+''501Jg1 State zip 3TZ-57
Phone QIo$ - (c83 -75133 ' Cell go4- 145-0` 5
Email rlMvt a 1'knilc Vt ides .G"A
Applicant Signature V(
CITvsrAFir USE oNLY
Application p uT I L 1 8 -['ir c.( 5—
Water System Development Charge $ It 1 y a o6 �TJ�c�
Sewer System Development Charge $ �il)� , CP7 -OI.tTS /
Water Meter Only $ / LS, ep
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $ 50. z3b
Other $
TOTAL c/2 s'— Cie—) (Notes)
APPROVED Kayle Moore, P.E. Date L (P
Public Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED