HomeMy WebLinkAboutSEWAGE CONSTRUCTION & INSTALLATION PERMITApplicant
I
Septic tank c
aerobic unit
Septic tank c
aerobic unit
Graywater
;tank
Laundry
(waste tank
Other Requii
(a) Installat
(b) A 6ystei
(c) Final ins
(d) invert of
Invert o'
Invert of
Invert of
,(e) Fill quail
6
1
j(f) Other:
Note:, C
f
jAUDIT
a 41
STATE OF FLORIDA
(DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE.SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERggANNEE
Authority: Chapter 3.81, FS BY
Chapter 10D-6, FAC �• 11i�Q@��1�
),A&�)In4 Permit Number Zq417 SO
-- P I - SYSTEM CONSTRUCTI SPECIFICATIONS AND CONSTRUCTION APPROVAL -------------
Treatment Tank Minimum Draintrench OR Minimum Absorption
Size Bed Size
Grease -
gallons interceptor gallons Square Feet ` S Square Feet
. zxq
gallons Dosing tank gallons Square Feet Square Feet
gallons
Square
Feet
Square
Feet
gallons
Square
Feet
Square
Feet
n must be in accord with requirements of chapter 10D-6, FAC.
construction permit is alid for a period of one calendar year from date of issue.
Jlation inspection an proval, is required before the system is covered. ¢ <<
;tub -out for to be benchmark.
;tub -out for to be benchmark.
;tub -out for to be benchmark.
tub -but for to be benchmark.
and quantity: A Z
EXCAVATION MUST BE CHECKED
DRAINFIELD INSTALLATION.
F MUST BE GUTTERED PRIOR TO FINAL APPROVAL.
and specifications by:
Title &D L
Date
copies of this form will be provided to the applicant,. installer and the building department.
)L NO. 62107 SQUARE MILE
by:
County Public Health Unit
1 HRS-H Form 4016, 42 85 (Obsoletes previous editions which may not be used)
(Stock Numben5744{�p01-4016-0) _ - Page 1 of 2