HomeMy WebLinkAboutSEWAGE CONSTRUCTION & INSTALLATIONSTATE OF FLORIDA
DKPARTMENt OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Authority: Chap.lerP-81, FS SCANNED
Chapter 1 OD-6, FAC BY
Applican,t PermitNumbe,r
...........
Treatment Tank Minimu.... PART I - SYSTEM CONSTRUCTION Sii1fG-IF,-Iq," 16NS AND C.QNSTRUCTION APPROVAL---------------
b.rraintrenc "OR= Minimum Absorption
hlze M -4'Bed Size
Septic tank, -,or Grease
aerobic unit I . gallons interceptor gallons Feet Square Feet
Septic tank:or
aerobic unii- gallons Dosing tank- gallons Square Feet Square Feet
Graywater i.
tank gallons Square Feet Square Feet
Laundry J
waste tank gallons 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 a�d approval is required before the system is covered..,
(d) Invert of stub -out, for �12 to be benchmark.
Invert of stub -out for, to be benchmark.
Invert of stub -out for to be benchmark.
Invert o, stub -out for to be benchmark.
(e) Fill quality and quantity:
1 11,
t
(J 11) 7
(f) Other: 0 7
System design and specifications y: Title
Construction authorized by: Date —_7
J_
County Public Health Unit
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL NO.
HRS-H Form 4016, Feb 85 (Obsoletes previous editions which may not, be used) (Stock Number. 0.44-001-4016-0) Page1 of 2