2282 Sandy Bay Lane Util18-0060 ccA05z;
City of Atlantic Beach
ECEIVEPUBUC UTILITIES DEPARTMENT
11fW�1I 1200 Sandpiper Lane
OCT 15 2018 U Atlantic Beach,FL 32233
(904)247-5834
NEW WATER EW TA REQUEST
Date 10/17— Project Address_ ZZ42 4A*JO') 5k"1 L 4,,J E
Number of Units Commercial_ Residential Y Multi-Family_
New Water Ta s &Meters 3 d
Tap(s) O� Meter Sizes)
New Irrigation Meter Upgrade Existing Meter from to
(size)
New Reclaim Water Meter_ ,,11 .�.Size New Connection to City Sewer
Applicant Name A
t`JEr.J gri.-A -,nc- B3 I. iiEA$ yyr„f�
Applicant Address-5-6—15 Miy.JIt14 JgFj aG= SaJrTE Zo(m
City �iAC�I��OF��t State ZIP z2�j
Phone O"1 d -15 33 Cell 904- "5j-&S05
EmailiW1 Q lanit 1Vt �c� coal
Applicant Signature � V
CITY STAFF USE ONCY
Application M UTI L I $ - /1L (cQ
Water System Development Charge $ (uvr UV
Sewer System Development Charge $
Water Meter Only $ (A S-1
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection
Other $
TOTAL $ ..J Z�r 1.10
-� (Nates)
APPROVED ' c1� Date
Public Ut/Bl,s Dlrecto or AulhotlzedSlgnature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED