2347 FIDDLERS LN - UTILITY a ( 3
-svljj"� REcEivE. City
q r �-s of Atlantic Beach
PUBLIC UTILITIES DEPARTMENT
15 NOV 6 2018
902 Assisi Lane
�~ Jacksonville, FL 32233
`''' ume
gills) BY: — (904) 247-5834
NEW WATER / SEWER TAP REQUEST
Date 7 -alp-9.6( Service Address 9,3y7 Fi ler, L.civ\ '_. i AtiabdIC 43each,FL
Number of Units 1 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 ...1I,L1,e }"\Ct,V VADNc).
Billing Address 2 3`} 1 Filc>< le_rs L a1n
City At 1avi4i e. e.a e_V1 State
rel) ' D
Phone 703 -- 58) - Li D5 q ►yr..
Email _ u vVt0 Iltd •O • • kiA til . r /A NOV 1 9 2018
I
Applicant Signatu _ ,,.;`_ ; 4, .-i :a.- ti. epartment
1R,+:,- ni
CITY STAFF USE ONLY
Application # 'e` 40Ob,3
Water System Development Charge $ /, /97d, OD
Sewer System Development Charge $
Water Meter Only $
Reclaim Meter Only $
Water Meter Tap $ Ste. tit)
Sewer Tap $
Cross Connection $ c5D, 60
Other $
TOTAL $ / 990, 00 (Notes)
APPROVED / < i cei, r Date //—
Public Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED