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INDIAN RIVER COUNTY- WATER AND SEWER CONNECTION FEES <br />1015 Commerce Avenue <br />Property Owner: I Am Ministries <br />Project/Subdivision Name: ' <br />Property Owner Contact Person: <br />Location/Street Address: <br />Parcel ID ('s) #: <br />1015 Commerce Avenue <br />Phone ; 772-978-0601 <br />Cell #: <br />Fax #: <br />e -Mail: <br />Fire Protection Service? (Yes / No) (REQUIRED) APPLICABLE CODE <br />( I ) Indian River County/City of Sebastian <br />Master Meter? (Yes / No) �N (REQUIRED) (V) City of Vero Beach BI Water <br />( F) Franchise Utility I Sewer <br />( N) No Service Available (REQUIRED FIELDS) <br />FIELDS BELOW MUST BE FILLED <br />Water & Sewer are available and must connect. <br />For Concurrency Only? (Yes / No) �N <br />Connecting to Water (y or n) <br />Y <br />N <br />Is Temp Service Agmt Required <br />Connecting to Sewer (y or n) <br />Y <br />WATER: Financed ? <br />Water Impact Fee: <br />ERU's @ $1,300.00 Each <br />= $ <br />Tap Size # of taps <br />Water Service Connection: <br />_ $ <br />Water Deposit: <br />Deposit @ $50.00 per ERU <br />= $ <br />Inspection Fee <br />= $ <br />Meter Size # of meters <br />Meter Installation <br />= $ <br />Water Line Within Cnty RW: <br />_ <br />If Developers Agmt = 1 <br />= <br />If Master Planned Line = 2 <br />SEWER: Financed ? <br />Sewer Impact Fee: 5 n <br />ERU's @ $2,796.00 Each <br />= $ <br />13,980.00 <br /># of taps <br />Sewer Tap (yes or no): <br />_ $ <br />_ <br />Sewer Deposit: 5 <br />Deposit @ $50.00 per ERU <br />= $ <br />250.00 <br />Inspection Fee <br />Inspection Fee @ $25.00 <br />= $ <br />Sewer Line Within Cnty RW <br />$15.77/LF 125 <br />= $ <br />1,972.25 <br />If Developers Agmt = 1 <br />= <br />If Master Planned Line = 2 <br />MISCELLANEOUS: <br />Service Charge <br />= $ <br />25.00 <br />Additional Deposit Per DDCV <br />Number of DDCV's Required = <br />_ $ <br />- <br />Recording Fee <br />= <br />Doc Stam <br />= <br />Remarks : C..-- ill... d.p,-i&F-4.r.—hipdh.. pp4i.,,f..—i— c— ill...d <br />m g.. • auillio vd,,g P—h f d.. BuiWing D.pa.wc.c c.m,.mi.. h.. f« d,. p.im.r......d.. f.,... <br />ne,) will be e —,,.- bifi y h ea. m .h. home oars. Pk... Prim....hu e....h.e. h bigprenaidh y.. vhrn <br />---- Official Use by IRCUD Staff Only <br />lLaced B�� Date — —Praced <br />---- <br />cryo.h....nrq... rion.,pl—g,,i.much.id, — Water system <br />purchased from General Development <br />Gordon Sparks 3/2/2016 <br />hereby aciniowledge that I have been informed a a permit is required by <br />the Building Department for the installation of the service line from the meter. <br />IRC Service App Provided? <br />Failure to obtain this permit may result in a delay in the installation of the <br />meter A copy of this application will be furnished to the Building Department <br />for their records. <br />Total Balance Due *** <br />_ $ <br />16,227.25 <br />Customer Dame. <br />"'Charges and fees are estimates onlv .Actual charges arc <br />subject to revim, and <br />Customer Signature: <br />confirmation at nme of payment. Sen -ice Availability Pees will accrue at the nine connection <br />Date: <br />fees have been paid. <br />Bait rnmea: 3/-/-616 <br />92 <br />