HomeMy WebLinkAboutSEWAGE CONSTRUCTION & INSTALLATION PERMITM1 .a
A —7'
STATE OF F�ORIDA
DEPARTi'I E`0 OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
®� Authority: Chapter 381, FS
• '� Chapter 10D-6, FAG
Applicant #i 4; ,,.y 1 -= Permit Number f
............... PAR`T,ly-SYSTEM CONSTRUCTION SPECIFICA4IVS'AND CONSTRUCTION APPROVAL---------------
!
Treatment Tank Minimum Draintrench OR Minimum Absorption
Size Bed Size
Septic tank oriJ Grease_
��gallons interceptor ft
aerobic unit gallons Square Feet � Square Feet
Septic tank or d �'
aerobic unit._ gallons Dosing tank gallons Square Feet Square Feet
G raywater ,
tank gallons e4 Square Feet Square Feet
Laundry
waste tank gallons 4 Square Feet Square Feet
Other Requirements: ¢
(a) Installation must be in accord with requirements of" chapter 1OD`-6, FAC.
(b) A system !construction permit is valid for a --period of one calendar year from date of issue.
(c) Final installation inspection acid approval ig required before the system is covered.
y��.� to be ,1 ¢) `,. ,r r benchmark.
(d) Invert of .tub -out for ;�� �` ����
Invert of stub -out for to be benchmark.
Invert of stub -out ° , benchmark.
Invert of Stub -out for,to be
for to be benchmark.
(e) Fill quality and quantity: 'o-
E7,
I
��s R�
Other � TO
LL�i
G PIN'AL
System design and specifications by:4 l �� 1 �, Title
Constructido authorized by:. k __ Dated
!Cio, County Public Health Unit
i
Note: Conjpleted copies of this form will be provided to the applicant, installer and the building department..
AUDIT CONTROL NO. Y
i
HRS-H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number; 5744.001-4016.0) Page 1 Of 2