335 2ND ST - NEW WATER/SEWER JS r J 'is, CITY OF ATLANTIC BEACH
PUBLIC UTILITIES
1200 Sandpiper Lane
\
ATLANTIC BEACH, FL 32233
orti9'r (904) 270-2535 or (904) 247-5874
NEW WATER/SEWER TAP REQUEST
Date: 2/10/14 Project Address: 335 2nd St.
No. of Units: 1 Commercial Residential X Multi-Family
New Water Tap(s) & Meter(s)_existing—relocating meter Meter Size(s)__3/4"_
New Irrigation Meter Upgrade Existing Meter from to (size)
New Connection to City Sewer
Name: Audrey Wagner
Applicant Address: . 335 2"d St.
City: State: FL Zip:
Phone Number: Cell Number: 678-491-8994
Email Address Audrey.wagner@effem.com Fax:
Signature:
(Applicant)
CITY STAFF USE ONLY
Application#
Property is being subdivided. Resident wishes to
Water System Development Charge $
relocate existing meter closer to existing home.
Sewer System Development Charge $ Cost is for new tap/meter($800)less the cost of the
Water Meter Only $ meter since it is existing($185)for a total cost of
Water Meter Tap (relocate) $ 615.00 $615.
Sewer Tap $ —
Cross Connection $
Other $
TOTAL S, 615.00
APPROVED: Donna Kaluzniak 2/10/14
(Utility Director or Authorized Signature)
ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES
CAN BE ASSESSED