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STATE OF FLORIDA PERMIT NO.�1,59pog
DEPARTMENT OF HEALTH DATE PAID :
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: Ljtv6,Ll?
<, SYSTEMwr RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[✓] New System [ J Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary [ ]
APPLICANT: LARRY & JULIET HURRAY 4L � Q
AGENT: NANCY ARMSTRONG TELEPHONE: 863-529-2370
MAILING ADDRESS: 807 NE PARK ST OKEECHOBEE, FL 34972 nancyarmstrong6l@ginail.com
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: 3 BLOCK: SUBDIVISION: SERENITY AT THE PRESERVE PLATTED:
PROPERTY ID #: 3228-600-0003-000-2 ZONING: AG-5 I/M OR EQUIVALENT: [ Y' ]
PROPERTY SIZE: 5.120 ACRES WATER SUPPLY: [ ✓] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y/IV ^] DISTANCE TO SEWER: IJ (. FT
PROPERTY ADDRESS:
DIRECTIONS TO PROPERTY: SEE ATTACHED
BUILDING INFORMATION
Unit Type of
No Establishment
1 NEW
2
3
[✓] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Soft Table 1, Chapter 64E-6, FAC
3 1386
4
[ ] Floor/E"ment Drains [ ] Other (Specify)
SIGNATURE: l I ( IL
DATE: UG 1
DH 4015, 08/09 (Obsoletes Wevious editions whVch may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
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