2270 Sandy Bay Ln UTIL18-0046 ECEIVUT'tL tg -66yj0
JUN 2 9 2018 City of Atlantic Beach
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� PUBLIC UTILITIES DEPARTMENT
' gy 1200 Sandpiper Lane
Atlantic Beach,FL 32233
nsiUY (904)247-5834
NEW WATER/SEWER TAP REQUEST
Date 12 - Project Address _aop-109
Number of Units Commercial_ Residential Multi-Family_
i
New Water Tap(s)&Meter(s)� Meter Sizes) 3 q
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclaim Water Meter_ ,t ,,Size New Connection to City Sewer_
Applicant Name �El..r /'�' t-h+-�Tt C. vt �O EIL.S YIr1G .
Applicant Address X75 MI4it�iG T>✓Rit+n;g $ulTE 20(0
City :1'A<-0-50tJNA State zip 3ZZ'57
Phone 0/41 — (0$3 —1533 1 II Cell 904— 5,45'o'9>05
Email t(M Q. �4n"t'lc \)t low(' .CyA
Applicant Signaturey
CITYSTAFF USE ONLY
Application# W11 L If? — UO t((a (7 5
(O Aci•
Water System Development Charge 51. 1140. OCA Gt
Sewer System Development Charge $ �, 0 �. CS(� - D fti I 0�- ' /
Water Meter Only $
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $ $Q (I
Other $
TOTAL $ S c/ZS, -do
(Notes)
APPROVED Kayle Moore, P.E. Date 1 1
Public Utilities Director or Authorized signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED