2009 Mayport Rd UTIL18-0056 & UTIL18-0057 water sewer tap request fees l� T Z L l
s City of Atlantic Beach
PUBLIC UTILITIES DEPARTMENT
r j 902 Assisi Lane
! cp �R1 Jacksonville, FL 32233
BY (904) 247-5834
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NEW WATER / SEWER TAP REQUEST
Date - d�� Service Address 9 ,), 67
Number of Units Commercial Residential Multi-Family
New Water Tap(s) & Meter(s) Meter Size(s)
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclaim Water Meter Size New Connection to City Sewer
Applicant Name
Billing Address 0 3- 41 C ek2 bQ� k # `l
City Ofd CC E� [ J bJ 0 A Z� State- Zip
(Zone �L � d— 3 S �� �
Email ( �i ]✓� V��2 t�f �° �� � C/' `t�✓� �/ `'
t
Applicant Signature Z :�91 ZAZ::��/T
CITY STAFF USE ONLY
Application # 4T/L / (D 5( � �, to
Water System Development Charge $
Sewer System Development Charge $ 24', SES_ 00
Water Meter Only $
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $
Other $
TOTAL $ �3 _ (Notes)
APPROVED Date /
Public Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED
City of Atlantic Beach
A97 PUBLIC UTILITIES DEPARTMENT
f aV: 902 Assisi Lane
Jacksonville, FL 32233
(904) 247-5834
NEW WATER / SEWER TAP REQUEST
- �- O l Pal
Date P
� J Service Address d
Number of Units Commercial Residential Multi-Family
t�
New Water Tap(s) & Meter(s) Meter Size(s)
New Irrigation Meter v Upgrade Existing Meter from to (size)
New Reclaim Water Meter Size New Connection to City Sewer
Applicant Name "� I'�— ✓�
Billing Address
City State Zip 6 l
ho
Email
Applicant Signature
CITY STAFF USE ONLY
Application#QT J (. ( � — ��s7 tX/.3T/A/1O �" .SkWi e_C
�y Nis A W ZiESS, A10 SD
Water System Development Charge $
Sewer System Development Charge $
Water Meter Only $
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $
Other $
TOTAL $ Sir i (Notes)
APPROVED Date /911 P_
Public Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED