93/95 W 2nd St New Water/Tap City of Atlantic Beach
_ PUBLIC UTILITIES DEPARTMENT
902 Assisi Lane
.. Jacksonville, FL 32233
(904)247-5834
� 1 NEW WATER// SEE�WER TAP REQUEST
Date "I Service Address I
Numberof Units Commercial 0_ Residential Multi-Family
New Water Tap(s)&Meter(s)F-If Meter Size(s) 3 y
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclaim WaterMeter
1� Size New Connection to City Sewer 21
Applicant Name 1Ul—�ya
Billing Address
City - lU` C State�_ Zip A�L'
Phone _ 1N_ JJ r�,��
Email MA(1CA I1 e \ __
n
Applicant Signature s
CITY STAFF USE ONLY
Application#
Water Syst
Sewer Sysb (/��'
Water Me[ ""\ lel ( (e Ic�SU�
Reclaim Mc r \ I �e�
Water (Met, `-V 1 J
Sewer Tap
Cross OtherConn, U O _ � �Zs
do
TOTAL Lo b �`lJ t ( _ $ SO 00 (Notes)
Cbl eonneC�
APPROVED
ALL TAP REC,----- - Inc VUdLIL U I ILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED