HomeMy WebLinkAboutD O H SEWAGE TREATMENT - DISPOSAL APPLICATION PERMIT 7-24-18I
{E
o� STATE OF FLORIDA
" r DEPARTMENT OF HEALTH
P ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
ON FOR:
PERMIT NO.S O (,a,?
DATE PAID:
FEE PAID:
RECEIPT #:
I New System [ ] Existing System I ] Holding Tank [ ] Innovative
[ ] Repair [ ] Abandonment [ ] Temporary or I l
APPLICANT : Nicholas & Heather Tubito 0))4 (% 7 ' V e - 71 & 2
AGENT: Alexander J. Piazza PSM, Inc. TELEPHONE: 772-340-7770
i
MAILING ADDRESS : 619 SW Biltmore Street, Port St. Lucie, Florida 34983
---------------------------------
TO BE MPLETED 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.
PROPERTYIINFORMATION
LOT: BLOCK: SUBDIVISION: PLATTED: NON
PROPERTY ID #: 3409-114-0004-000-2 ZONING: R I/M OR EQUIVALENT: [ No ]
PROPERTY SIZE: 3.771 ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [,/]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FSY [ No I DISTANCE TO SEWER: FT
PROPERTY ADDRESS: Oleander Avenue, FT. PIERCE, FL 34982
DIRECTIONS TO PROPERTY: SEE MAP
BUILDING INFORMATION
Unit Type of
No Establishment
1 RESIDENCE
2
3
4
[ -/ ] RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
3 3,677
[ l Floolr/Equipment Drains [ �/ ] Other (Specify) GARBAGE GRINDERS / DISPOSALS
iIGNATURE• " / � jj '�;;,� / DATE: 7-24-18
1H 4015, 08/09 (Obsoletes'previous editions which may not be used)
ncorporated 64E-6.001, FAC Page 1 of 4