HomeMy WebLinkAboutSEWAGE APPLICATION FOR CONSTRUCTION PERMIT� E S� 7M Z3313
o STATE OF FLORIDA PERMIT NO.
4 F� •' PAID:
DEPARTMENT OF HEALTH DATE -�=—
`w ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: 01S
.�r�.
SYSTEM RECEIPT # : � loc���
VIE APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR: Innovative•
[ ] New System [ ] Existing System [ ] Holding Tank I ]
[ ] Repair [4/] Abandonment [ ] Temporary [ ]
APPLICANT: Chobee Land Enterprises Co
AGENT: Reliable Treasure coast Services Indian River Septic TELEPHONE: 772-562-4242
MAILING ADDRESS: PO Box 1116, Vero Beach, FL 32961
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
APPLICANTfS RESPONSIBILITY.TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS -
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PROPERTY PROPERTY INFORMATION
LOT: BLOCK: SUBDIVISION: Metes and Bounds
PLATTED: Pre-1972
PROPERTY .ID #: 2323-331-0000-000-5
ZONING: Al-1
I/M OR EQUIVALENT:
[ No El ]
PROPERTY SIZE: 19.22 ACRES WATER SUPPLY:
[,e] PRIVATE
PUBLIC [ ]<=200.0GPD [
]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065,•FS? [
No H! ]
DISTANCE,TO SEWER:
N/A FT
PROPERTY ADDRESS: 8560 Okeechobee Rd. Fort Pierce, FL-34945
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1 Single Family
2
3
4
[ ] Floor/Equipment.Drains
SIGNATURE:
[ ] RESIDENTIAL ' [ ] CO- ACIAL
No.' of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
4 2592
[ ] Other (Specify)
DATE : November 18, 2021
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Page 1 of 4
Incorporated 64E-6.001, FAC