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FIELDS BELOW MUST BE FILLED <br />INDIAN RIVER COUNTY- WATER AND SEWER CONNECTION FEES <br />1125 27th Ave SW <br />•Property Omer. St Pierre <br />Connecting to Water (y or n) <br />Phone; <br />Project/Subdivision Name: <br />Is Temp Service Agmt Required <br />Cell #: <br />Property Owner Contact Person: <br />Connecting to Sewer (y or n) <br />Fax #: <br />Location/Street Address: <br />1125 27th Ave <br />WATER: Financed? <br />a -Mail: <br />Parcel ID ('s) #: <br />33-39-27-00001-0080-00002.1 <br />= $ <br />Fire Protection Service? (Yes J No) <br />LTJ (REQUIRED) <br />APPLICABLE CODE <br />Water Service Connection Fee: <br />_ $ <br />(I) Indian River County/City of Sebastian <br />Master Meter? (Yes / No) <br />� (REQUIRED) <br />(V ) City of Vero Beach. <br />I Water <br />= $ <br />25,00 <br />(F) Franchise Utility <br />BSewer <br />Meter Installation 1 1 5/8 -inch @ $130.00 <br />(N ) No Service Available <br />(REiQUIRED FIELDS) <br />FIELDS BELOW MUST BE FILLED <br />Water & Sewer are available and must cconnect.�ec <br />For Concurrency Only? (Yes / No) MN <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 />N <br />WATER: Financed? <br />Water Impact Fee: 1 N ERU's @ $1,300.00 Each <br />= $ <br />1,300.00 <br />Water Service Connection Fee: <br />_ $ <br />3,809.62 <br />Water Deposit: 1 Deposit @ $50.00 per ERU <br />= $ <br />50.00 <br />Inspection Fee 1 <br />= $ <br />25,00 <br />Meter Size # of meters <br />Meter Installation 1 1 5/8 -inch @ $130.00 <br />= $ <br />130.00 <br />Water Line Within Cnty RW: 2 <br />e <br />If Developers Agmt =1 Master Planned @ $11.25 per LF <br />LF= 100 = $ <br />'4125.00 <br />OLM8atef Planned Line = 2 <br />SEWER: Financed ? <br />Sewer Impact Fee: 1 N <br />= $ <br />2,796.00 <br />Sewer Service Connection Fee: TAP BY CONTRACTOR - UCP REQUIRED <br />= $ <br />- <br />PAID <br />Sewer Deposit:- 1 <br />= $ <br />50.00 <br />Inspection Fee N/A <br />r �p <br />D _ir ' 0 = $ <br />- <br />Sewer Line Within Cnty RW.- 2 <br />i'NDiAN RIVER <br />If Developers Agent =1 Master planned ®$15.77 per LF <br />r\DUNTY UTiLlTI _ $ <br />1,577.00 <br />If Master Planned Line = 2 <br />MISCELLANEOUS: <br />Service Charge 1 New Service @ $25.00 <br />= $ <br />25.00 <br />Additional Deposit Per DDCV Number of DDCV's Required = = $ <br />- <br />Recording Fee <br />_. <br />Doc Stam <br />c $ <br />Remarks : A private lift station designed and permitted by a F <br />fFci 1 y IRCUD Stafi`Only ---- <br />Professional Engineer, wilt he required in order to connect to <br />Da(g Prepared <br />County ewer. <br />Jesse R nd <br />12/19/2017 <br />I hereby acknowledge that i have been informed that a permit is required by the Building Department for installs on <br />IRC Service AM <br />Providedd <br />of the service line from the meter. IRCDUS recommends pressure testing your existing plumbing befor ansitioning <br />Total Balance Due *ate _ $10 <br />887.62 <br />from your private well system to the County's water service. Pressure testing will allow you to avoid any potential leaks <br />or breaks that may occur due to the pressure change with your new County water service. IRCDUS is not responsible <br />„s ®" <br />Charges and icaretima <br />es estimates only. Achml <br />for leaks or breaks that may occur due to connection to the County water system . <br />charges are subject to review and con&mladon <br />t time of payment Service Availability fees will <br />accrue at the time connection fees <br />have been <br />paid. <br />ustomer Signature: <br />Date: <br />Date Printed: 12/19/2017 <br />