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STATE OF FLORIDA`''
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
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Authority: Chapter 381, FS
Chapter 10D-6, FAC �� fx,i -, ail
9 9 Y V l
- I G&A-ES Permit Number
PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL -------------
Septic tank f
aerobic unit 1�05dgallons
Septic tank r
aerobic unit'_ gallons
Graywater i
tank 'I gallons
Laundry
waste tank gallons
Other Requ
(a) Install
(b) A sysi
(c) Final i
(d) Invert
Invert
Invert
Invert
(e) Fill
Treatment Tank
Grease
interceptor gallons
Dosing tank gallons
Minimum Draintrench
Size
Square Feet
Square Feet
Square Feet
Square Feet
OR Minimum Absorption
Bed Size
O ® Square Feet
Square Feet
Square Feet
Square Feet
m must be in accord with requirements of chapter 10D-6, FAC.
i construction permit is valid for a period of one calendar year from date of issue.
allation inspection and approval is required before the system is co a ed.,,
stub -out for HouSE to be UC C- L D benchmark.
stub -out for Dmi"Lrw1C5 to be -'Z1 ") Ar0ouE lo—_ L %Zt)AP benchmark.
stub -out for to be benchmark.
stub -out for / q to beLC?"`P_C--D)
benchmark.
y and quantity: A i `?C l! X r
EXCAVATION MUST BE CHECK
DRAINFIELD INSTALLATION.
iMadLiVESM
(f) Other:,
ROOF M&ST BE GUTTERED PRIOR TO FINAL APPROVAL.
System d''sign and sp cifica 'on y Title
Construc ion authorized by:. G�/ Date
County Public Health Unit
Note- C14-001-4016-0)
fpleted copies o tF's form will be provided to the applicant, installer and the building department.
AUDITNTROL N10. 106684 SQUARE MILE
HRS-H Form Feb 85 (Obsoletes previous editions which may not be used)
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