HomeMy WebLinkAboutSEWAGE CONSTRUCTION & INSTALLATION PERMITSTATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES'
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Authority: Chapter 381, FS.
ANO C'hapter'1OD-6, FAC
Apphcant 1 "" Permit Number
-------PART I SYSTEM CONS
T UCTIO SPECIFICATIONS AND CONSTRUCTION APPROVAL-----------
Treatment Tank Minimum Draintrench OR Minimum Absorption
Size Bed Size
Septic tank or--,,
aerobic unit f gallons
Septic tank or
aerobic unit- gallons
Graywater
tank T gallons
Laundry
waste tank gallons
Other Requirements:
Grease
interceptor gallons
Dosing tank gallons
Square Feet Square Feet
01 t� f
Square Feet Square Feet
Square 'Feet Square Feet
Square Feet Square Feet.
(a) Installation must be in accord with requirements of chapter 10D-6, FAC.
(b) A system construction permit is valid for a period of one calendar year from date of issue.
(c) Final installation inspectio and approval is required before the system is covered.
(d) Invest of stub -out forf to be >:.Ire- benchmark.
Invert of stub -out for to be benchmark.
Invert of stub -out for to be benchmark.
Invert of stub -out for to be benchmark.
(e) Fill quality and quantity:
_- by `'. v... k.. •: �, �,, t _ Sl �.. i�, I�_'., `31
i
(fl Other: C1 0 r
;i,
-rih a .p a, 4., r as_ i 4
System design and specifications by: 1• �, - ` Title
Construction authorized by: ? Date
1'
County Public Health Unit
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL 140.
HRS•H Form 4016,, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-001-4p16.0) Page 1 of 2