HomeMy WebLinkAboutD O H TREATMENT - DISPOSAL - CONSTRUCTION AND INSTALLATION PERMITSTATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Authority: Chapter 381, FS
Chapter 1 OD-6, FAC
(9�
Applicant 1111I Permit Number
M�is+ &S
---------------PART I - YSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL---------------
Treatment Tank Minimum Draintrench OR
Minimum Absorption
Size
Bed Size
Septic tank forr Grease
interceptor Square Feet
Square Feet
aerobic uniallons gallons
Septic tankior
C51-K9
aerobic unit gallons Dosing tank gallons Square Feet
Square Feet
Graywater
tank gallons Square Feet
Square Feet
Laundry
waste tank gallons Square Feet
Square Feet
I
'3- 4VAje®
Other'Req irements:
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a) Installation must be in accord with requirements of chapter 1 OD-6, FAC.
(b) A system construction permit is valid for a period of one calendar year from date of issue.®���Y
(c) Final installation inspection and approval is required before the systm is co rye ed.� if
/x /�
(d) Invert of stub -out for /? to be n mae-K- -
cnv
Invert 'of stub -out for to be
benclimark.
Invert of stub -out for to be
benchmark.
Invertlof stub -out for to be
benchmark.
(e) Fill quality and quantity: A
I EXCAVATION MUST BE CHECKED
BY THIS DEPARTMENT PRIOR TO
I DRAINFIELD INSTALLATION.
I
I
(f) Other: IF AREA OF DRAINFIELD IS SUBJECT TO SATURATION FROM ROOF DRAINAGE,
IROOF MUST BE GUTTERED PRIOR TO FINAL APPROVAL.
I '
System design and specifications
Construction authorized by:
i
St. Lucie
County Public Health Unit
Title r,--S --
Date Zr
Act
Note! Completed copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL NO. 090007
HRS-H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 6744-001-4016-0) Page 1 of 2