The URL can be used to link to this page

Home My WebLink AboutApplication For Construction PermitSTATE OF FLORIDA DEPARTMENT OF HEALTH P ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [✓] New System [ ] Existing System [ ] Holding Tank [ ] Repair [ ] Abandonment [ ] Temporary APPLICANT: CHRISTOPHER R. HUTCHINGS AND MELISSA J. HUTCHINGS AGENT: GROUP ONE CONSTRUCTION PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: [ ] Innovative TELEPHONE: 772-742-2900 MAILING ADDRESS: 10302 SOUTH FEDERAL HIGHWAY NUMBER 164, PORT ST. LUCIE FLORIDA 34952 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: 31/30 BLOCK: 2 SUBDIVISION: INDIAN RIVER ESTATES UNIT ONE PLATTED: 1956 PROPERTY ID # : 3402-602-0074-000-0 ZONING: RS-3 I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 0.674 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [v ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 5001 PINETREE DRIVE, FORT PIERCE, FLORIDA 34982 DIRECTIONS TO PROPERTY: TAKE U.S. HIGHWAY NO. ONE TO MIDWAY ROAD; GO EAST ON MIDWAY ROAD TO PINETREE DRIVE; GO SOUTH ON PINETREE DRIVE AND LOTS ARE ON THE RIGHT. BUILDING INFORMATION Unit Type of No Establishment 1 SINGLE FAMILY 2 3 4 [✓] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 4 2093 [ ] Floor/Equipment Drains [ ] Other (Specify) J , Ai l SIGNATURE: DATE: 08/28/2017 DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [✓] New System [ ] Existing System [ ] Holding Tank [ ] Repair [ ] Abandonment [ ] Temporary APPLICANT: CHRISTOPHER R. HUTCHINGS AND MELISSA J. HUTCHINGS AGENT: GROUP ONE CONSTRUCTION PERMIT NO. s% S/479y0 96, DATE PAID: FEE PAID: RECEIPT #: [ ] Innovative [ l TELEPHONE: 772-742-2900 MAILING ADDRESS: 10302 SOUTH FEDERAL HIGHWAY NUMBER 164, PORT ST. LUCIE FLORIDA 34952 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: 31/30 BLOCK: 2 SUBDIVISION: INDIAN RIVER ESTATES UNIT ONE PLATTED: 1956 PROPERTY ID #: 3402-602-0074-000-0 ZONING: RS-3 I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 0.674 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [✓ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 5001 PINETREE DRIVE, FORT PIERCE, FLORIDA 34982 DIRECTIONS TO PROPERTY: TAKE U.S. HIGHWAY NO. ONE TO MIDWAY ROAD; GO EAST ON MIDWAY ROAD TO PINETREE DRIVE; GO SOUTH ON PINETREE DRIVE AND LOTS ARE ON THE RIGHT. BUILDING INFORMATION Unit Type of No Establishment 1 SINGLE FAMILY [ ✓ ] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 4 2093 2 3 4 [ ] Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: DATE: 08/28/2017 0 DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 ce STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [✓] New System [ ] Existing System [ ] Holding Tank [ ] Repair [ ] Abandonment [ ] Temporary APPLICANT: CHRISTOPHER R. HUTCHINGS AND MELISSA J. HUTCHINGS PERMIT NO. SG-5/'- /7911o* DATE PAID: FEE PAID: RECEIPT #: [ ] Innovative AGENT: GROUP ONE CONSTRUCTION TELEPHONE: 772-742-2900 MAILING ADDRESS: 10302 SOUTH FEDERAL HIGHWAY NUMBER 164, PORT ST. LUCIE FLORIDA 34952 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: 31/30 BLOCK: 2 SUBDIVISION: INDIAN RIVER ESTATES UNIT ONE PLATTED: 1956 PROPERTY ID #: 3402-602-0074-000-0 ZONING: RS-3 I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 0.674 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [,/]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 5001 PINETREE DRIVE, FORT PIERCE, FLORIDA 34982 DIRECTIONS TO PROPERTY: TAKE U.S. HIGHWAY NO. ONE TO MIDWAY ROAD; GO EAST ON MIDWAY ROAD TO PINETREE DRIVE; GO SOUTH ON PINETREE DRIVE AND LOTS ARE ON THE RIGHT. BUILDING 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 SINGLE FAMILY 4 2093 2 3 4 [ ] Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: DATE: 08/28/2017 DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 I dE STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [✓] New System [ ] Existing System [ ] Holding Tank [ ] Repair [ ] Abandonment [ ] Temporary APPLICANT: CHRISTOPHER R. HUTCHINGS AND MELISSA J. HUTCHINGS AGENT: GROUP ONE CONSTRUCTION PERMIT NO. MIOY& DATE PAID: FEE PAID: RECEIPT #: C-- [ ] Innovative TELEPHONE: 772-742-2900 MAILING ADDRESS: 10302 SOUTH FEDERAL HIGHWAY NUMBER 164, PORT ST. LUCIE FLORIDA 34952 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: 31/30 BLOCK: 2 SUBDIVISION: INDIAN RIVER ESTATES UNIT ONE PLATTED: 1956 PROPERTY ID # : 3402-602-0074-000-0 ZONING: RS-3 I/M OR EQUIVALENT: [ No ] PROPERTY SIZE: 0.674 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [✓ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: 5001 PINETREE DRIVE, FORT PIERCE, FLORIDA 34982 DIRECTIONS TO PROPERTY: TAKE U.S. HIGHWAY NO. ONE TO MIDWAY ROAD; GO EAST ON MIDWAY ROAD TO PINETREE DRIVE; GO SOUTH ON PINETREE DRIVE AND LOTS ARE ON THE RIGHT. BUILDING INFORMATION Unit Type of No Establishment 1 SINGLE FAMILY 2 3 4 [ ✓ ] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 4 2093 [ ] Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: SIGNATURE: DATE: 08/28/2017 DR 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4