HomeMy WebLinkAboutSewage PermitSTATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Authority: Chapter 381, FS
Chapter 10D-6;,FAC
Applicant V v � E &a �� • �� 1 t L Permit Number
� r�s
J r
------------ PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL --------------
Treatment Tank ( Minimum Draintrench OR Minimum Absorption
Size Bed Size
Septic tank or^ Grease
aerobic unit 7C gallons interceptor gallons Square Feet S Square Feet "
Septic tank or
aerobic unit gallons
Graywater
tank gallons
Laundry
waste tank gallons
Dosing tank gallons
Square Feet
Square Feet
Square Feet
Square Feet
Square Feet
Square Feet
Other Requirements:
(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 , cov red.
(d) Invert of stub -out forDLlScto be el` iLo/NIC2 benchmark.
Invert 'of stub -out for to be benchmark.
Invert of stub -out for to be benchmark.
Invert of stub -out for - to be benchmark.
(e) Fill quality and quantity A
EXCAVATION MUST BE CHECKED
BY THIS.DEPARTMENT PRIOR TO lS
DRAINFIELD.INSTALLATION.
Af) Other: IF AREA OF DRAINFIELD IS SUBJECT TO SATURATION FROM ROOF DRAINAGE,
ROOF MUST BE GUTTERED PRIOR TO FINAL APPROVAL.
System ,design and specifications
Construction authorized -by: '
v St. Lucie County Public Health Unit
Title
Date 4h hZ
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
h AUDIT CONTROL NO. -1.3 9 C V 6 SQUARE MILE ✓y
HRS-H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
(stook Numberr5744-001-4016-0) Page 1 of 2