740 SAILFISH DR - UTILITIES RECEIVED
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AUG 2 4 20te City of Atlantic Beach
PUBLIC UTILITIES DEPARTMENT
902 Assisi Lane
\T-')V Building Department Jacksonville, FL 32233
City of Atlantic Beach, FL (904) 247-5834
NEW WATER / SEWER TAP REQUEST
AUG 2 7 2018
I it
Date a 2-tService Address —1 tii0 ci64\ uc' _
Number of Units Commercial Residential ✓ Multi-Family
New Water Tap(s) & Meter(s) ( Meter Size(s) 44'
New Irrigation Meter V Upgrade Existing Meter from to (size)
New Reclaim Water Meter Size New Connection to City Sewer
Applicant Name (ii-t1 V-xnMJJ— - dam, SIL; pfteQ, AS�(vts Boot_ gviLO-RQs>
Billing Address --740 S \ S-1-)
City r9 C, R d\ State f" ` Zip 32233
Phone (GICb) Z& 1 -- (5(e1
Email An4 , n rer.: 5 • :I1'1►��,CpM
Cfre #1611#/4-461"
Applicant Signature I ' CA-V-1 Connor- ?Ott 588-L}4iO
CITY STAFF USE ONLY
Application # C,t'T IL —/ Q - • 0 53
Water System Development Charge $ / 4Q oQ
Sewer System Development Charge $
Water Meter Only $
Reclaim Meter Only $
Water Meter Tap $ 800,UCS
Sewer Tap $
Cross Connection $ 50
Other $
TOTAL $ 11990 , 00
(Notes)
APPROVED `2'/ ' i- Date ar-- C2 - �f
Public Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED