HomeMy WebLinkAboutSEWAGE CONSTRUCTION & INSTALLATION PERMITf`
-
IT—. q. ,. i r'1 n
r
A.� a
.�., -... Ja-r l.(,"r'•-•Y-v'..... ,,. vir, r 1. . .! f. .r �. '
i...r •J• 4 ^.. .S Tr r,ji.../• .yr r`
•� p I n -
`
»i""NF��
---4 o
STATE OF FLORIDA
DOARTMENT OF
HEALTH AND REHABILITATIVE SERVICES
m
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
_
SCANNEV
•,"fin we
BY
Authority: Chapter 381, FS
Chapter 1 OD-6;, FAC
�7
Applicant �.�f..
pP
1�1�s �' `�'" �'��~�
..
Permit Number 4- 7
--------------- ARtA
- SYSTEM C NSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL---------------
Treatment Tank
Minimum Draintrench OR Minimum Absorption
li
Size Bed Size
Septic tan '.� ors Grease
?�rgallons interceptor
Square Feet -)75 Square Feet
iaerobicun'
gallons
Septic tan for
z �
!aerobic un.i
gallons Dosing tank
gallons Square Feet Square Feet
Graywater
tank
gallons
Square Feet Square Feet
Laundry
waste tank''I
gallons
Square Feet Square Feet
Other Requ�!
(a) Installatf
(�) A system
(c) Final ins
(d) Invert of
• Invert of,
Ifivert of
Invert of
(e) Fill quali
n must be in accord with requirements of chapter 1 OD-6, FAC.
construction permit is valid for a period of one calendar year from date of issue.
illation inspectioand approval is required before the stem is cove ed.
;tub -out for d- A ',S Q to be � !ter ��F- fcwuok Or 0 ( benchmark.
;tub -out for to be benchmark.
;tub -out for to be benchmark.
>tub -out for to ha henchmark.
and quantity:
BY THIS DEPARTMENT PRIOR TO
I'
to
,}
llKA+ V' B1jD
l Il
NS'J�AL.i,A'1'IUN
— 1 I t r a
I
`
(f) Other. REA OF
DRAINFIELD
IS SUBJECT TO SATURATION FROM ROOF DRAINAGE,
MUST
BE GUTTERED
PRIOR TO FINAL APPROVAL,
� Ind
System desig� and specifications by: ( 1:hnt^�..v� Title r
C nstruction l uthorized by: _ ! �(LV"c —� Date
St:. Lua e County Public Health Unit
N te: Compl Ited copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONT , OL`NO.
1-W
HRS-H Form 4016, Fe 85 (Obs6etes previous editions which may not be used)
(Stook Number. 5744-0 1.4016 0)
y ... .
Page 1 of 2