2798&2800 SHANRI LA WATER/SEW REQ City of Atlantic Beach
PUBLIC UTILITIES DEPARTMENT
902 Assisi Lane
/ Jacksonville, FL 32233
(904) 247-5834
NEW WATER / SEWER TAP REQUEST U I ( L- i1 9 _a o
Date I hqI hService Address Sham(
Number of Units Commercial M/ Residential Multi-Family
New Water Tap(s) I(Meter(S�f Meter Size(s) tr
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclaim Water Meter Q_ Size New Connection to City Sewer 0—
Applicant Name _ meirI Con C_ � � LLC
Billing Address 4e5D • i,t -�1-�
City � 1 --� �V► 1� State Zip
Phone /c"I -2,5 1 —
Email
Applicant Signature
pP g
CITY STAFF USE ONLY
Application # LLTlL I q - 00 7 METt✓L,S tV;ll A,07 43.E ,S
n!%! L lDfir,"4-e4:29 Mc70 t_
Water System Development Charge $ 2, 2 80. ob px3 rl'4U c Lac-t,J 1?;gDA
.
Sewer System Development Charge $_ 80 / DU , 06 �it x P Glass v1/i1�tYC ji3X U
Water Meter Only $_ 370,610 Z7,4-o G r-2 ) 6111
Reclaim Meter Only $
Water Meter Tap $ S�Z./c 2 &,.iN tZTIu►1� ►v+sS�
Sewer Tap $ -
Cross Connection $
Other $ n
TOTAL $ lO, gz l oy
(Notes)
APPROVED Date
P is Utilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED
PUBLIC UTILITIES PLAN REVIEW COMMENTS
Date: ZS Application#: ( l (�
1-7
Project Address: 2-71 Z ?C)O h c,(I I
Check Box Check
APPLICATION TRACKING COMMENTS to Ada Box to
Comment Print
Underground Avoid damage to underground water and sewer utilities. Verify vertical and
Water Sewer horizontal location of utilities. Hand dig if necessary. If field coordination is
Utilities needed,call 247-5878.
Meter Boxes Ensure all meter boxes, sewer cleanouts and valve covers are set to grade
Sewer Cleanout and visible.
A sewer cleanout must be installed at the property line. Cleanout must be
RT1 Sewer covered with an RT1 concrete box with metal lid. Cleanout to be set to grade Ej
Cleanout and visible.
A reduced pressure zone backflow preventer must be installed if irrigation will
RPZ be provided or if there is a private well on the property. Backflow preventer ❑ ❑
Backflow must be tested by a certified tester and a copy of the results sent to Public
Utilities.
Plans note the building will be unsprinkled. If plans change, any fire line
Sensus installed must be metered with a Sensus touch-read meter in a properly sized
Touch-Read vault and an appropriate backflow preventer installed. Backflow preventer ❑ ❑
Meter must be tested by a certified tester and a copy of the results sent to Public
Utilities.
Fire
Spri kler If fire sprinkler system is provided,call 247-5878 for backflow requirements.Backf13 ❑
Requirement At a minimum, will require a double check backflow preventer.
Fire Line Fire lines must be metered with a Sensus touch-read meter. Meters larger ❑ ❑
Meter than 2" must be installed in a vault as noted in JEA specifications.
Utility Map See attached Utility Map. ❑ ❑
Disconnect
&Cap Disconnect and cap water and sewer lines. ❑ ❑
Inspection Must call the Inspection Line at 247-5814 to request an inspection of the
Prior disconnected and capped water and sewer lines prior to demolition. ❑
❑ ❑
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