HomeMy WebLinkAboutSewage PermitSTATE OF FLORIDA g
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Authority: Chapter 381, FS
Chapter 10D-6, FAC
Applicant l 'nte- , Permit Number
------------ PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL -------------
Septic tank or
aerobic unit Z;,!�allons
Septic tank or
aerobic unit gallons
Graywater
tank gallons
Laundry
waste tank gallons
Other Requirements:
Treatment Tank Minimum Draintrench OR - Minimum Absorption
Size Bed Size
Grease
interceptor gallons Square Feet Square Feet
Dosing tank gallons Square Feet quare Feet
Square Feet
Square Feet
Square Feet
Square Feet
(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 a
�r
approval is required before the system is coy �fe .
1 � Fl a® VL-:.
_
(d)
Invert of stub -out for
� to be
Invert of stub -out for
to be
benchmark.
Invert of stub -out for
to be
benchmark.
Invert of stub -out for
to be
benchmark.
A ' 7 X-r57 5 1562)
(e)
Fill quality and quantity:
. 4`
EXCAVATION MUST
E CHECKED
BY THIS DEPARTMENT PRIOR TO
DRAINFIELD INSTALLATION •
�y���c
AM CMO/p
- <"�-r c rya
f /�- C arr a,� Al , c�i�/�
r
b -.) 6� c _ /Z
A^c 0 ll-ears 19 •I i2 I,4/ ecLr ► c yJI-r-ol't • -
(f) Other: TF AREA OF DRAINFTELD IS SUBJECT TO SATURATION FROM ROOF DRATNAGF,
ROOF MUST BE GUTTERED PRIOR TO FINAL APPROVAL.
Tie, Wg '7-0 LC S C^' veea 6" 16x- -# Y Aet0F 0 ,'0 f1iCwt A& ice&1,i1l/�.v
System design and specific ti s by: -� Title �
Construction authorized by: Z' Date
County Public Health Unit
Note: Completed copies of tft form will be provided to the applicant, installer and the building department.
AUDIT CONTROL NO. 111285 SQUARE MILE
HRS-H Form 4016. Feb 85 (Obsoletes previous editions which may not be used)
(Stook Numberr5744-001-4016-0) - Page 1 of 2