HomeMy WebLinkAboutSEWAGE CONSTRUCTION & INSTALLATION PERMITSTATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE�,� E�l L1rCEiDISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
.�coD � Q��, Authority: Chapter 381, FS
we St. ����\
II Chapter 1 OD-6, FAC
Applicant
--------------- PA
Septic tank c
aerobic unit -
Se
ptic tank c
aerobic unit_
G raywater
tank _
Laundry
waste tank _
Other Require
(a)
Installation
(b)
A system c
(c)
Final instal
(d)
Invert of st
Invert of st
Invert of st
Invert of st
{e) Fill quality
y _Permit Number Z%S2-
I - SYSTEM CONSTRU 4SPIEUIFICATIONS AND CONSTRUCTION APPROVAL--------------- \
Treatment Tank
Grease
gallons interceptor gallons
gallons Dosing tank gallons
gallons
gallons
Minimum Draintrench OR
Size
Square Feet
Square Feet
Square Feet
Square Feet
Minimum Absorption
Bed Size
Square Feet
Square Feet
Square Feet
Square Feet
nust be in accord with requirements of chapter 1OD-6, FAC.
nstruction permi is valid for a period of one calendar year from date of issue.
ition inspectionInd approval is required before the systep is covered. C
b-out for to be ,� ` IAA V� [. �D�D benchmark.
b-out for to be benchmark.
b-out for to be benchmark.
bout for to be benchmark.
ROO
System design a;
Construction a
quantity:
EXCAVATION MUST
DRAINFIELD INSTALLATION.
specifications by:
ed by:
County Public Health Unit
Titles
Date
Note:,Compieted copies of this form will be provided to the applicant, installer and the building department.
090070
AUDIt CONTROL NO. -
II I,
HRS-H Form 4016, Feb 85 (4bsoletes previous editions which may not be used)
(Stock Number. 5744.001-40 ,6.0) Page 1 Of 2