1651 MARITIME OAK DR - UTILITY (lel ( I - a� �
RECEIVED
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ECEIVE+
City of Atlantic Beach
iQ i i '� NOV 8 2018 PUBLIC UTILITIES DEPARTMENT
OV902 Assisi Lane
BY: _ Jacksonville, FL 32233
Building'-' t o'i ment (904) 247-5834
City of Atlantic Beach, FL NEW WATER / SEWER TAP REQUEST
Date Of/ Service Address / 5/ 4 /A Me, (:)6/ /lam
Number of Units //_ Commercial Residential Multi-Family
2 maw,e ole h-
New Water Taps) & Meter(s) Meter Sizes) pel Ed /0(ci (i bv►
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclaim Water Meter Size New Connecti n to City Sewer
Applicant Name A't'e iJ AOmt5 (/1/ -Kit/ -
Billing Address /.22 760 SGh �oJe__ Alm/ ,Sv/
City /;(1.SSMIw./k— State A Zip 3,2.2-2 3
Phone OY ,2_9 S-- 2, 5.----
Email
Email A idle✓g 1 4 er-Si4 104,t• (04, -
Applicant Signature / /,
CITY STAFF USE ONLY
Application# UTI L IS — 00(.0(00 lc-t�CU oe,4i-4-- ,��e- - t x t
Water System Development Charge $ �'<
Sewer System Development Charge $
Water Meter Only $
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection $
Other $ ?SO, CZ
TOTAL $ 3SD, CD
'/(Notes)
APPROVED �� Date //—�/d"
(614
blit Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED