HomeMy WebLinkAboutD O H SEWAGE TREATMENT - DISPOSAL APPLICATION CONSTRUCTION PERMIT 7-27-18STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[✓] (New System [ ] Existing System
[ ] Repair [ ] Abandonment
APPLICANT : BSE CONSTRUCTION GROUP
AGENTI: BSE CONSTRUCTION GROUP
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #:
[ ] Holding Tank [ ] Innovative
[ ] Temporary [ ]
TELEPHONE: 772-3 ?210 ,
WWII
ADDRESS: 535 NW MERCANTILE PLACE, UNIT 107, PORT ST. LUCIE, FL 34986 _ By
TO BEICOMPLETED 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.
INFORMATION
LOT: ' BLOCK: SUBDIVISION:
PLATTED:
PROPERTY ID #: 2421-234-0005-000-3 ZONING: RS-4 I/M OR EQUIVALENT: [ No
PROPERTY SIZE: 0.548 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [V ]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ No ] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 2208 CORTEXBOULEVARD, FORT PIERCE
DIRECTIONS TO PROPERTY: FROM VIRGINIA GO SOUTH ON 25TH STREET TO CORTEZ BLVD AND GO EAST TO
TO PLACID STREET AND THE PROPERTY IS ON THE LEFT.
BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design
14o (Establishment Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
1 SINGLE FAMILY 2 1000
I
2 1
3
4
[ ] (Floor/Equipment Diains [ ] Other (Specify)
SIGNATURE:
DATE: 07/27/2018
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
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