Util20-0046 City of Atlantic Beach
UTIL20-0046 PUBLIC UTILITIES DEPARTMENT
51902 Assisi Lane
Jacksonville, FL 32233
-ors (904)247-5886
NEW WATER/SEWER TAP REQUEST
Date 74777 0 Service Address_ 886 n('PFln Rl%/d
Number of Units,- Commercial_ Residential_ Multi-Family_
New Water Tap(s) & Meter(s) _ Meter Size(s) .75
New Irrigation Meter Upgrade Existing Meter from to (size)
New Reclaim Water Meter_ Size New Connection to City Sewer
ApplicantName-American Classic Homps
Billing Address
City State Zip
Phone
Email caM0)arh [Ir tlet
Applicant Signature
CITYSTAFF USE ONLY
Application M Util 20-0046 All fees must be paid before meter
Water System Development Charge s 1140.00 settestablishing service.
Sewer System Development Charge s 401;n nn
Water Meter Only $
Reclaim Meter Only S
Water Meter Tap 5
Sewer Tap ** *S
Cross Connection
Other 5
TOTAL � , 0q0' co (Notes)
APPROVED "___2`/(�- Date
Public tilities Director or Authorized Signature
ALL TAP REQUESTS MUST BE APPROVED BY THE PUBLIC UTILITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED