HomeMy WebLinkAboutD O H SEWAGE TREATMENT - DISPOSAL PERMIT APPLICATIONAPPI
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[ ]
AGENT:
9b STATE OF FLORIDA PERMIT NO. �,�td0 �� J
DEPARTMENT OF HEALTH DATE PAID:
ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID:
SYSTEM RECEIPT #:
APPLICATION FOR CONSTRUCTION PERMIT
'ION FOR:
!w System [ ] Existing System
pair [ ] Abandonment
FT: Walter E. Saitta
1chael J. Grzelka, P.E:
ADDRESS: 2507 SE West Blackwell
[ ] Holding Tank [ ] Innovative
[ ] Temporary [ ]
Cell 772-201-1108
TELEPHONE: 772-337-0448
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.
� I
PROPERTY INFORMATION
'.� North 165' of east It of lot 7
LOT: 71 BLOCK: 3 SUBDIVISION: St. Lucie Gardens PLATTED: 1911
PROPERTY ID #: 3414-501-1107-050-0 ZONING: AR-1 I/M OR EQUIVALENT: [ Y /(N)]
PROPERTY SIZE: 1.25_ ACRES WATER SUPPLY: .[X]-PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /(N)] DISTANCE TO SEWER: 5000+/- FT
r PROPERTY ADDRESS: TBD Tilton Road '
L DIRECTIONS TO PROPERTY: From US-1 go east on Dyer rd., turn left on Silver Oak, Turn right
On Tilton, head east on Tilton to the intersection of Shana's Trail. Go throw h the
Intersection. Lot is on the south side approx. 400' east of Shana's Trail
BUILDING INFORMATION [X] RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sqft Table,l, Chapter 64E-6, FAC
1
Home 3 2331
2
3 Garage 0 780 f
_ -
[12] Moor/Equipment Dra'ns rer—(Specify)
SIGNATURE:
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DH 4015, 10/97 (Previous Editions May Be Used)
DATE:• G
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