HomeMy WebLinkAboutD O H SEWAGE TREATMENT APPLICATION PERMIT - 2APPLICANT: J
AGENT:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
?OR:
:tem Existing System [ ] Holding Tank
[ ] Abandonment [ ] Temporary
& Svlvia Lawson
SURVEYING INC
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:_
[ ] Innovativeel/�
[ l
TELEPHONE(772) 288 7206
ADDRESS: 2740 SW MARTIN DOWNS BLVD #333, PALM CITY, FL. 34990
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE
CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES.
IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS
CREATED',OR PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER
PROVISIONS.
PROPERTY INFORMATION
LOT: 3 IBLOCK: N/A SUBDIVISION: RIVER BRANCH ESTATES PLATTED: August 1989
I '
PROPERTY ID #: 3404-809-0007-000-1 ZONING: I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE: 0.50 ACRES WATER SUPPLY: [] PRIVATE PUBLIC ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 51.44 Cherry Palm Way, Fort Pierce Fl. 34981
DIRECTIONS TO PROPERTY: SEE ATTACHED
I
BUILDING INFORMATION RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
No Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
i
1
RESIDENCE 3 2220
2
3
4
[ ] Floor/Equipment Drains [ ] Ot
SIGNATURE:
( Specify)
Fix
DATE: 7-10-18
DH 4015,;10/97 (Previous Edit�on4 May Be Used) ONLINE VERSION Page 1 of 4
�\....//
APPLICANT: Property owner's full name.
AGENT: Property owner's legally authorized representative.