HomeMy WebLinkAboutApplication For Construction Permit ( Sewage )64 � ,
STATE OF FLORIDA PERMIT NO.
�" ' DEPARTMENT OF , HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
y SIP' SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[V/] New System [ ] Existing System [ ] Holding Tank Innovative
[ ] Repair [ ] Abandonment [ ] Temporary
APPLICANT: Joseph W. & Sondra W. Jaksch
AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE: 772-340-7770
MAILING ADDRESS: 619 SW Biltmore Street, Port St. Lucie, FL 34983
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR,489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTY INFORMATION
LOT: 6 BLOCK: 17 SUBDIVISION: IndrioUnit#1 PLATTED: 1925
PROPERTY ID.#: 1416-601-0060-000-3 ZONING: R I/M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 0.276 ACRES WATER SUPPLY: [�/] PRIVATE PUBLIC [ ]<=2000GPD-[ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ]' DISTANCE TO SEWER: n/a FT
PROPERTY ADDRESS: 4640 Arcadia Avenue, Fort Pierce, FL 34946
DIRECTIONS TO PROPERTY: SEE LOCATION MAP
c
'4UILDING INFORMATION [,/] RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
,No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
1 Residential 2 1,013
2
3
4
[ ] Floor/Equipment Drains
SIGNATURE:
(,:�,! ] epther (Specify) GARBAGE GRINDERS / DISPOSALS
71 .
DATE: 6-04-12
DH 4015; 08/09 (Obsoletes p
Incorporated 64E76.001, FAC
which may not be used)
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