HomeMy WebLinkAboutSewage0
STATE OF FLORIDA
4RTMENT OF HEALTH AND REHABILITATIVE SERVICES
SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Authority: Chapter 381, FS
Chapter 10D-6, FAC
Applicant ,� � T. �f.�/-i.� � v / i�'u� Permit Number 274?'1
77
------------ PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL -------------
Septic tank or
aerobic unit % gallons
Septic tank or
aerobic unit gallons
Graywater
tank gallons
Laundry
waste tank gallons
Treatment Tank
Grease
interceptor gallons
Dosing tank // gallons
1111'_r Ile
Minimum Draintrench
Size1 r
Square Feet, �`
Square Feet
Square Feet
Square Feet
OR Minimum Absorption
Bed Size
Square Feet
Square Feet
Square Feet
Square Feet
Other Requirements: N
(a) Installation must be in accord with requirements of chapter 10D-6, FAC.
(b) A system construction permit is valid for a period of one calendar year from date of issue.
(c) Final installation inspection and approval is required before the system is covered. ,!,
�
(d) Invert of stub -out for �r%/a.r� �A �% �� , ->/ err`" to be P��/ /% >l % ,���r �/
benchmark.
Invertof stub -out for to be
benchmark.
Invert of stub -out for to be
benchmark.
Invert of stub -out for to be
benchmark.
r
„(e) Fill quality and quantity: A _
EXCAVATION MUSrff IIE CHECKED
RV fm4T R DT, PAR PT4 T\T1P PRTQ'R IVO
DRAIN IEL D INS ALLZT c ION.
%rS � ��1 �A ^ ^ �ICy� ✓'l g /1..,� � ! (`• n .it �i _ ! �/t/' /v` _ -? i l./%:�,✓.+ ../-� .r9 f' ' �s . , /: f / 1i%!'�✓,r /% ,/!'�/?� '�
(f) Other:.-rr nw r-%PRTAT�TT7-T.TI T-_ o'STn.-ir..rp rrn CZAr'T1?Qi1r'TQWT PPO'`.9 TQQR nPATRIAO-R.
ROOF LUSDi BE GUTTERED PRIOR TO FIII1L APPRO'JAL,
System design and specifications, by: %=SFr, %! -, r f�A<^�=. =�'�_� . Title
Constr ctiono authorized by: Date
✓'
County Public Health Unit
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL NO. 62,095
HRS-H Form 4016,'Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number.-5744-001-4016-0) Page 1 of 2