1639 MARITIME OAK DR - UTILITY buii ( 18 - 0 6
ECEIV �.
js `' NOV 8 2018 City of Atlantic Beach
1, 11PUBLIC UTILITIES DEPARTMENT
BY. 902 Assisi Lane
Jacksonville, FL 32233
1'..-c ,' (904) 247-5834
NEW WATER / SEWER TAP REQUEST
Date 'IMO( Service Address Uo 31 1'\Ar+'wA_ bcck Ail\-
Number of Units A Commercial Residential v Multi-Family
New Water Tap(s) & Meter(s) Meter Size(s)
New Irrigation Meter Upgrade Existing • - ; rom to (size)
New Reclaim Water Meter Size New Connection to City - - * YMPe- OltMIPS
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Applicant Name ( ‘7\1?-( S lek- \i`OY1 S (flI1 'Atitk Moe
Billing Address d\ Sin -12` 1 Nuc/ SU14e ( -o
City -17AC.ICSNU it 14. State I REtVED
Phone -lay- „,20,5-._ 6, m)
Email
rd"e76 M r1WfSiC- `)fL < <o-. NOV 19 2018
Applicant Signature7 z� Building Department
C ty of At antic Beach, Ft_
CITY STAFF USE ONLY
Application# (tri L i E - 00 (011
TEloc.4-rt MET- X Z
Water System Development Charge $
Sewer System Development Charge $
Water Meter Only $
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $
Other $ 7®O. an
TOTAL $ _ 7 L 0o f (Notes)
/ Or
APPROVED _ —iii16...._ Date //1-117
ublic Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED