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HomeMy WebLinkAboutSEWAGE APPLICATION FOR CONSTRUCTIONSCANNEG °� Fo STATE OF FLORIDA BY DEPARTMENT OF HEALTH RR - ONSITE SEWAGE DISPOSAL SYSTLL Cov APPLICATION FOR CONSTRUCTION PERMIT APO ION FOR: [ )Row System- [ ] Existing System [ ] epair [ ]/Abandonment ,Q,( APPLI �DiC� PERMIT NO. DATE PAID FEE PAID: RECEIPT 1: [ ] Holding Tank [ ] 'Innovative [ ] Temporary [ TELEPHONE:�4�' MAILI G ADDRESS: 9 � �iLLr�J lgleC' TO BE COMP BY APPLICANT OR-APPLICANT*S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A 11�ERSON LICENSED PURSUANT TO 489.105(3)(a) OR 489.552, FLORIDA STATUTES. PROPERTY INFORMATION LOT: �I BLOCK: 1_5 SUBDIVISION: / / ez �/�1vPLATTED: ��' —2� I PROPE ID if: ZONING: I/K OR EQUIVALENT: [ Y / N ] J PROPER�Y SIZE: ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC I�=20OOGPD [ ]>2000GPD I� IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y N• DISTANCE TO SEWER: FT' PROPE TY ADDRESS: (��� DIREC�( IONS TO PROPERTY: 1 l' kh - 6u /Ij lip _ ,`G !/.0 �© ��F�11/.cIDG� �C c%D , ��7%7i��G�f ✓G ✓>O TO L of 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 3 . 4 [ I. I;F1oor/E ipment rai [ ] Other (Specify) SIG t DATE: � �v� or DH I, 015, 10/9 — Page 1 (Previous editions may be used) Sto,. Number: 5744-001-4015-1 Page 1 of 3 I pF'S�1E STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM WE SITE EVALUATION AND SYSTEM SPECIFICATIONS i APPLI I AGENT: �N��J�� Aldm(20s ZAjo LOT: BLOCK: � SUBDIVISION: PROPERTY ID #: [Section/Township/Range/Parcel No. or Tax ID Number] ------------------------------------------------------------------------- ----------------- ---- TO BE COIF LETED BY ENGINEER,- HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S, MUST PROVIDE GISTRATION NUMBER AND SIGN AND SEAL 'EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. ----------------------------------- PROPERTYSIZE CONFORMS TO SITE PLAN: [✓f TOTAL ES IMATED SEWAGE FLOW: AUTHORIZiD SEWAGE FLOW: UNOBSTRU TED AREA AVAILABLE: REFERENCE POINT LOCATION: YES [ ] NO NET USABLE AREA AVAILABLE: Q'lr�. ACRES GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 21 GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE] SQFT UNOBSTRUCTED AREA REQUIRED ��� SQFT S/, V/4? - /j/j ELEVATIO OF PROPOSED SYSTEM SITE IS INCHES/FT] [ABOVE/BELOW]. BENCHMARK/ REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURE SURFACE HATER: XOp FT DITCHES/SWALES: F.T. NORMALLY WET? [ ] YES [ NO ;WELLS: P LIC: 2 66 FT LIMITED USE: 6D FT PRIVATE: _ �' FT NON -POTABLE: _-525� FT BUILDING FOUNDATIONS: _- FT PROPERTY LINES: �L FT POTABLE WATER LINES: FT SITE SUB 'ECT,TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING? [ ] YES [ 11 NO 10 YEAR OOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD SOIL .PROOILE INFORMATION SITE 1 Munsell Color Texture Depth to to to to to to to to to USDA SOIL SERIES: 'SOIL PROFILE INFORMATION SITE 2 Munsell #/Color Texture Depth to to to to to to to to to USDA SOIL SERIES: I OBSERVEb'WATER TABLE: INCHES [ABOVE / BELOW] ESISTING GRADE. TYPE: [PERCHED / APPARENT]! ESTIMATE WET SEASON WATER TABLE ELEVATION:_, INCHES [ ABOVE /'SOW ] ESISTING GRADE. HIGH WA T R TABLE --VEGETATION.: [ ] YES_ .[wrNO MOTTLING: [] YES [`�JNO_. DEPTH: INCHE ISOIL TEX /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES 1DRAINFIE1D CONFIGURATION: [ ] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ DITIONAL CRITERIA: 'SITE EV IIUATED BY: / C�� �pC� DATE: i DH 4015, 10/96' Replaces HRS-H Form 4015 [Page 3] which may be used) Page 3 of 3 (Stock Number:115744-003-4015-1) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM ION PERMIT FOR: OSTDS New PERMIT #:56-SF-973815 APPLICATION #: AP914282 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR766678 _ 4 PROPERTY ADDRESS: Oak Dr Fort Pierce, FL 3495 LOT: ! 5 BLOCK: 3 SUBDIVISION: Fort Pierce Shores PROP RTY ID #: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] f [OR TAX ID NUMBER] II SYST iM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381. 065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATI FACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICI SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PER T APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISS CE OF THIS .PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STAT,, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. d SYST M DESIGN AND SPECIFICATIONS y T [ 900 ] GALLONS / GPD SeDtic CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY ( ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 462 ] SQUARE FEET SYSTEM R [ ] SQUARE FEET N/A SYSTEM A T E SYSTEM: [ ] STANDARD [ ],FILLED [X.1 MOUND [ ] I CO IGURATION: [ ] TRENCH [X] BED [ ] N F LC ATION OF BENCHMARK: Top of orange paint @ base of Right Curve Sign @ NW P/L. I ELEVATION OF PROPOSED SYSTEM SITE [ 1.00 ][ INCHES FT I ABOVE BELOW]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 8.00 ][ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT L D F L REQUIRED: [ 25.0 ] INCHES EXCAVATION REQUIRED: [ 84.00 ] INCHES O installation to be in accordance with s. 64E-6.013(3)(0, FAC. SWT determined through USDA web soils, historical data, soil stripping. T cavation certification to be submitted prior to inspection. H E R SPECIFICATIONS BY: John C Hanlon TITLE: Environmental Specialist II APPROVED BY: TITLE: Environmental Specialist II St. Lucie CHD John C Hanson DATE I ISSUED : 03/11 /200 EXPIRATION DATE: 09/11 /201 I DH 4016, 10/97 (Previous Editions May Be Used) Page 1 of 3 v 1.1.4 AP914282 SE781959 I STATE OF FLORIDA APPLICATION # AP914282 DEPARTMENT OF HEALTH PERMIT # 56-SF-973815 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DOCUMENT # SE781959 SITE EVALUATION AND SYSTEM SPECIFICATION APPL ANT: Newland Contracting Inc i CONT TOR / AGENT: Abacus Land Surveyors LOT: 5 BLOCK: 3 SUB6VISION: Fort Pierce Shores ID#: TO EI COMPLETED BY ENGINEER HEALTH DEPARTMENT EMPLOYEE, OR OTBER-QUALIFIED PERSON. ENGINEERSMUST PROVIDE -'REGISTRATIONNUMBER AND 'SIGN AND SEAL EACH "PAGE"OF-SUBMITTAL:-COMPLETE -ALL -ITEMS.- PROPi RTY SIZE CONFORMS TO SITE PLAN: (X]YES [ ]NO NET"USABLE AREA AVAILABLE: 0.24 ACRES TOTAI; ESTIMATED. SEWAGE FLOW: 300 GALLONS PER DAY ( RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 599.98 GALLONS PER DAY [ 1500-GPD/ACRE OR 1 2500 GPD/ACRE ] UNOB RUCTED AREA AVAILABLE: 1500.00 SQFT UNOBSTRUCTED AREA REQUIRED: 932.00 SQFT BENC /REFERENCE POINT LOCATION: Top of orange paint @ base of Right Curve Sign @ NW P/L. EMV76TION OF PROPOSED SYSTEM SITE 1.00 [ INCHES / FT ] [ ABOVE]/ BELOW ] BENCHMARK/REFERENCE POINT THE DOINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES it SURF,IE WATER: n/a FT DITCHES/SWALES: 15 FT - NORMALLY WET: [ ]YES [X]NO I WELL PUBLIC: n/a FT LIMITED USE: n/a FT PRIVATE: n/a FT NON -POTABLE: 50 FT •BUIL NG FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 10 FT I v SITE iiUBJECT TO FREQUENT FLOODING? [ ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NO] 10 YJ FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD SOILtOPTLF! TNFORMATTON RTTR 1. ROTT. AROFTT.F. TN7ORMATTON RTTF. 9 USD I ',SOIL SERIES: Canaveral fine sand, 0 to 5 pert sell #/Color Texture Depth 1OYR 16/1 Fine Sand 0 To 12 1 OYR',4/3 Fine Sand 12 To 17 10YR 014 Fine Sand 17 To 19 1 OYR /4 ' Fine Sand 19 To 37 1 OYR 16/1 Loamy Coarse Sand 37 To 45 1OYR ;611 Refusal 45 To 72 USDA SOIL SERIES: Canaveral fine sand_, Munsell #/Color Texture 0 to 5 pare Depth 10YR 511 Fine Sand 0 To 12 1 OYR 4/3 Fine Sand 12 To 17 1 OYR 5/4 Fine Sand 17 To 19 1 OYR 6/4 Fine Sand 19 To 37 1 OYR 6/1 Loamy Fine Sand 37 To 45 1 OYR 6/1 Refusal 45 To 72 OBSEFIFED WATER TABLE: 33.00 INCHES [ ABOVE / BELOW ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 1 INCHES [ ABOVE / HELOW ] EXISTING GRADE HIGHi ER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [X]YES [ ]NO DEPTH: 17.00 INCHES SOIL.1TEXTURE/L6ADI1iG RATE FOR SYSTEM SIZING: Fine Sand/0.65 DEPTH OF EXCAVATION: 84 INCHES DRAI IELD CONFIGURATION: [ ] TRENCH [XI BED ( ] OTHER (SPECIFY) MARKS/ADDITIONAL CRITERIA I SITE (VALUATED BY: DATE: Hanson, John (Title: Environmental Specialist 11) (St Lucie County Environmental Heal DH 4Ii �5, 09/2006 (Previous Editions May Be Used) A0914282 EID973815 03/10/2009 Page 3 of 4 v 1.0.2 STATE OF FLORIDA PERMIT _NO. 0 DEPARTMENT OF HEALTH DATE PAID (} - ONSITE SEWAGE'DISPOSAL SYSTEM FEB PAIDs % APPLICATION FOR CONSTRUCTION PERMIT. RECEIPT if: Q D WE' I APP ION FOR: { New System [ ] Existing System [ ] Holding Tank I ] Innovative [ ] Repair I ] Abandonment ( ] Temporary I. ] APPLICANT:- ���TT,�J.CJ�" cJ,`'I'/J°S,j"y�'rl.��: - i%uc. ___.____...__ .�•��_Vl`�. _&/-Cf� AG / /X MAIL Ii1G ADDRESS:� \ % �G IIIXI rt� TO BE,:COMPLETED.BY APPIICANT.OR APPLICANT'S AUTHORIZED AGENT. .SYSTEMS MUST BE CONSTRUCTED BY A ( ERSON LICENSEDPURSUANT TO 4:89..105(3) (a) OR; 4.89..551, naRIDA STATUTES. PROPEtTY wINFORMATION -- LOT: BLOCKS SUBDIVISIONtC.z `JC/GJ PLATTED:, #ROPE ID 1: ZONINGS' I/M :OR SQUIVIILENTs [ Y / N ] :! PROPEIY SIZES �•� ACRES WATER SUPPLY: [ ].PRIVATE PUBLIC [ �<—=200'OGPD I ]>ZOOOGPD { IS SE IER AVAILABLE 1. AS PER 381.0065, FS? [ Y Q NUJ DISTANCE TO SEWER: FT PROPE -ADDRESS: DIREC IONS To PROPERTY: CJ"d cr, 77, &Zee�) 7-0 Al BUILD I�I NG INFORMATION a { ...],' RESIDENTIAL [ ] CQ1003RCIAL Unit ,Type of ;• No. of Building Commercial/Institutional System Design. No Establishment, Bedrooms Area Sqft Tsbls.1,.,.Chaptor 64E=6,,''PAC,;f�` . • . 3 4 f .[ ] . i.Floor/E ?...Other. (Specify) s=Tow, .DATE: 7 a9 DH 015110/97 — Page 1 (Prev io Is'edb6fis may be.used) page 1 of 3 sto k Number: 5744-00:1r4015-1 PROPE TOTAL AUTHO i MOBS BENC ELEVA THE M SURfv A WELLS BUILD SITE. z: YE. SOIL I COD WE APPL I CM i LOT: PROPERTI STATE.OF FLORIDA PERMIT # Y DEPARTMENT OF HEALTH'N ONSITE SEWAGE DISPOSAL SYSTEM" SITE EVAILUATION AND SYSTEM'SPECIFICATIONS /VG7"-�Ca' /oa CD�LJ //(�! �C� f AGENT:1.�� BLOCK: SUBDIVISION:' ID #: [Section/Township/Range/Parcel No., or Tax ID Number] --- - ----------- I ------------------------ 7 --------------- -------------- -- 7=)­ TO.BE,COMPLETED BY ItNGINEER,HEALTH UNIT EMPLOYEE; OR -OTHER QUALIFIEDPERSON. ENGINEER SS UST PROVIDE' GISTRATION--NUMBER AND SIGN'AND SEAL EACH -PAGE -OF -SUBMITTAL.. COMPLETE ALL ITEMS. — = _ = _ _ -_= _ -= T - --- ------ R_ TY SIZE CONFORMS TO _SITE., PLAN i a.� • [ YES ( ] NO .NET USABLE AREA. AVAILABLE.: .ACRES .ES IMATED.SEWAGE FLOW: GALLONS PER DAY :[RESIDENCES -TABLE 1 / OTHER -TABLE 2] RIZiD•SEWAGE FLOW:. GALLONS PER,DAY [1500.GPD/ACRE OR 2500 GPD/ACRE] TRU TED..AREA AVAILABLE //j..# SQFT UNOBSTRUCTED .AREA REQUIRED: /��' SQFT. /.REFERENCE .PO.INT LOCATION: TIO OF PROPOSED SYSTEM [INCHES/] [ABOVE/BELOW] BENCHMARK/REFERENCE POINT INII IUM SETBACK -WHICH CAN BE MAINTAINED FROM•THE PROPOSED :SYSTEM TO THE'FOLLOWI'NG FEATURES: CE - ATER ,x.Qo FT-• _ DITCHES/SWALES � FT NORMALLY WET? - .[ . ] YES. [ L] O RJBLIC: FT, LIMITED. USE. 6 FT PRIVATE: ,% FT NON -POTABLE`' FT INGIFOUNDATIONS: FT:. PROPERTY:' LINES.: FT .'POTABLE WATER LINES.: // FT SUBiECT TO,,,FREQUEhT FLOODING: [.] YES '[ NO'• 10 YEAR FLOODING? [ ] YES [ NO AR. OOD ELEVATION;FOR SITE-FT.,MSL/NGVD.,._SITE- .ELEVATION FT, MSL/NGVD. PRO,iILE INFORMATION SITE 1' 'SOIL PROFILE 'INFORMATION SITE.2. ell Color Texture.: Devth. Munsell:-#/Color: Texture Deuth`' ao ;,.. to ` I USDA SO I �� •---� �"".:i�-^'a�:..��.. •,-,."•mot., - l OBSERVED jWATER TABLE: INCHES '[ABOVE /BEL�t]^'SZ 2'I G ;;GRADE. TYPE [.PERCED / APPARENT] ;ESTIMATE T SE ON WATEW TABLE ELEVATION rr r ^ kA{.;INCH S [ ABO,VE/_OW ]-EXISTING GRAD O iINCHEESHIGH. A :,- ., ' SOIL TEX �LO,DI 1ATt:-.­F�0%oSYSTEM SIZING:, " DEPTH OF'EBCAVATION:INCHES �DRAINFIE D CO fi�GU (71Y ] TRENCH [ ] BED "j ] .'O`Tj (SPECIFY), . REMARKS/ DITIONAL' CRITERIA: SITE EV UATED BY ! c.� v�� ��... DATE:,:) •.`✓ page:. 3. of 3 DH 4015, 10/96 1 Replaces HRS-H Form'4015 [Page 3] which, may, be used] ' (Stock Number: 744-003-4015=1) 06/26 009 06:15 7724896764 CHAUNGLY & WILL1AM5 rraut nrainu 1 PERMIT APPLICATION TO �w■���� C+t ly',9'iYI T, RIEP�AIR, MlaDif Y', .:.. WON Penntt- -. •.� � osTos Perron �: OR ABANDON A WELL Feel Amoufn: ,�� •o � St. Luck l County I Dgp0 rtMent This iova must be compkrted by" Delta Envlm tat H"Ih Watx+1' Pr+agrams t elrtlftt ° atlall sontt'atator for appro�ral WUP : slag NW�t Ortva Pcd St. >:�. K 34M prig? to Won constfuction. 7 87 i Fax.MM.073-403 1. LAi(d W oOi1r.81Val -o! Pl I 7 Ovmer, v gel tVarrap of Rrtap P Ciransr.. Owner M,%ai gAddm:t6 Citk I Stele MP Owner FhQse rao 1 � t+taell LaCa (trq[il fuss and l7ilecladntr ` L o� tly I $ip3�_ Z 17 egrq e6 lotion hbdW 'sicn e. Eftk No., Lot No.) 4Letittlde /' L hrde ! Township / Range f gzdj ez MM G ay ntcador ss city f'State Zip Orflist PMnvNo. D rFFrx o. .......•...........N............................................•.f•...•.aanu.N.NN.uu.vnwnf.•N.uu.•r.•.•......................................06...0 ..............s..u•fl. �. Plato Ea WELU1 0Rant abandon nc CI ❑ a�n.r: Nrruvuuol.................... NN..NI........ ►.\. u••I.NI.Ntl ONI....•.vI■.NNr.....L....O...N.l.\.......••../...NI.•►......../.M..I......................•..q......• N....... 6r WELLTYPE. 31000 Family DrinWV ci Slagle Family Irrigation ❑ DOH Public Drinking (> Dtr*W < t s so Om CwmetUoMwvo teas than 2S peoptel or no aral =l Wnpaon) - WUP ReQWr*d, duplest Mrs ❑ DEF Public Ddnkb'g (> 15 Service Cwmedhm or Sm Am 25 people or more) - WUP Rtegt*W Q lCo c MMI kv igavon - WUP tzQrl{, h" Q III u nitar — ov..•1H❑ othar (Eoatnr f.....lw Nu..'..u.ulNu.u.N.N..aY..bfgrrw.giN.YN....•.o..rn•1....aaa..p...,....rvufr.•Ie.Ny.•a•lw.o.••..w.•...•q•..N•N.n..o.•.•.....N•.............. •. T.- SITE om: ❑ SEWER .SEPTIC PROPOSED DISTANCE TO CLOSEST SEPTIC OR 8. CUPI P: is a Water Use Permll.(WUP) requir+ 7 i� -YES NO (if YES WUP must be attached' 8. �o.TIE1rIt M1r1 H _ Q Other tcpdtn 10.16RC� 'iIMG METHQD:ntonitearnerSt Other (Expltl: - 11.wir G+D..N.si'..R...wwU�.w��.C...�'iON:pvC� Celb�-Sp Y .} ❑C■�ir■atwiartited Q Oar (E�k LTH DEPATME9T .i22 C ©1 �5,•.' uMa..N.gtIT @vu.11'.1A. rf. ff .N uu..Ne■ .1. /.... � C I• .•f..N..Na.I..N......IIftI ■... .l U. PER IT GONDITiUM$: and pmavide trts drilhr ltantp, PWIMIN e,id eettrtaw pma�sri>lMip oraioanmaina we Mtn It vom hxftn daes notooau► and su" is emu, �€�idlled aUd tart S inepeato� adeNi' SilEi O�i Ca eN9E" 'trine. a raltMpetsiar the "KID aseenaaed. --10:mold 11 antaSh d.wd am the poop~ mo lacom maid dewmes ta*nv to duNft slurWtaa. prop" Ww% aU onslts aid aepac syatente and&nmrHen or Dewar sya cis,. end atl.aWar applimble w ahltti W Florid& Smas end Florida AdrObtrative GoO. MRA ...... •.I•Nal.•I.1..a.t..R�....l.rl•I�.INNI•.M...f �f�NN..ItfI.11.INI•. s64o.NN...v W.. Y..I...IIINN.afY..•....1•...•..M•..•..I1.t../..............I..N N....}.NINI..IJI..... 1.S. M: ! COWRAMICTOR PERMIT AQRfGMffKT: OWNERIAGENT PERMIT AGGREEMENr. I haw that t wa Wtlplp wnh tiro appldoaWe rjft offft4lwldn Q FR91*bpatiMe Coda, and mat ; I car* obit I am the owner or tee p vp". 004he Wwmadm a w«br uva ur artrrlalet tsehe+ga ptt e..0 twedsa. ttir oe abmtn+9d , recto catnxrta loam ai wag . p,�a. :1v somrmmaanw l .m pray. of nv re sponewwtaa %fide' sap t a fro oeraty VW alreet6aalati rarsmond In Rift do". FWnft'Ad+TrkdsWvo Code (FA% i Ctnpter 3T3, Florida ataoms, to ma k"O t or prstptrrly ttbmdtxr Y" 64Fi�. F and+�2.�#, f'A,C. wiM:boa rtlNt�klad, H elaaMO eaW9lCloe o�oirri tee tltaNlialdtb a varlanao ; twtsl[; or.1 eHltly Mat l and fire apsM for thcvtwtar,• that tl+a bsrostrtatla app11olt1[arr tM appaed tbrend vtat4trfod {trlort0 dritNng I hretlferwrdrp 13eNt eN lr8arn+e�Yon pravlded err pfvMldod it [sattab, rnd ftt t tgTd Inrxmoed the QaMlsr urhle tlala appNrur Ia acctrXrM artd lhet t gill attlein apptot�al /mar tlwr iAder�l. stiffs, ar focal oespoOMbr7Me so tsbM ebwa. owner awinfftto pseeoamM of the m , Oa sE the dale�alOd algeneVwtd+tra ; DCH a ropniamaMe am" to lM wag sSte. OCM*K or a. a �-- o je . �- n btrei, WeNComtrtttdor l.IoeAeadVa. '-Owhn r,X/AQa1166$lbert+ Daps ....... !......•.................KN. Gr WftrM.BEL4 I'II'M!S LINE— FOR OFFMIAL UBE ONLX....:.........•........••....••.••. •�•. to rtmr��sto urrrt� nx+o�ta.YSlctrtFa er•�rwuun-r�s� a�tncat ot� rrrR�lle +or t� �: tt�cffi cawtnr ta�.'at t�►�er+I�raT .... ] 'rb�t�••,* tg:w�� sore aQ.n�r:'n�; orF tss�r • PenTAI M vwd By: t7�tano ato closest systtrm or sewer lhte: r_ Vdlc l3 CorM n►G&M MellK*. _ _ _ - -Grout Material: � trt�pecbars Cvrtxrtettta: _ - 1-1,4bile R# P-3:110 arow►tura: