2211 Sandy Bay Ln Water/Tap City of Atlantic Beach b
MhA 7_ PUBLIC UTILITIES DEPARTMENT
2019 1200 Sandpiper Lane
,. Atlantic Beach, FL 32233
• " (904)247-5834
11 NEW WATER/SEWER TAPREQUEST
Date .3 2 z t l Project Address Z z 11 Sa ,^/d �;�J A Ll L,1
Number of Units If Commercial_ Residential ✓ Multi-Family—
New Water 7ap(s)B:Meter(s) V/ Meter Sizes) 3 4
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclaim Water Meter_ A �Size New Connection to City Sewer_
Applicant Name t!`-+�t� /Ar-r&,ev, —n C_ �jvtt�¢E7L-� y �r..1G
Applicant Address 7 77 MIIJIf 4 Ti:� 'Lob
city Ltx- State_ Zip 22�J
Phone + 83 -7533 Cell 904 — 545-990`05
t .
Email (twtGpAN1
Applicant Signature, y i
CITY STAFF USE ONLY
Application# UTI L 1q — 002p
Water System Development Charge $ �y�•
SCANNED
Sewer System Development Charge $ 0- � Date: 111511 q
Water Meter Only $ Li]
Reclaim Meter Only $
Water Meter Tap $
Sewer Tap $
Cross Connection
Other $
TOTAL $ (A_ (Notes)
APPROVED ^ �� Date 2 7-f 9
Public Utilities D0or or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED