HomeMy WebLinkAboutD O H TREATMENT - DISPOSAL SYSTEM CONTRUCT - INSTALL PERMIT`r STATE OF FLORIDA
DEPARTMENTfOF KEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMI[T
Authority: Chapter 381, FS i_ xp�
Chapter 1 OD-6 FAC iJL_�
Applicant Permit Number -
PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL---------------
TreatmentTank
Septic tank oar
aerobic unit gallons
Septic tank or
aerobic unit gallons
Graywater
tank gallons
Laundry
waste tank gallons
Other Requirements:
Grease
interceptor gallons
Dosing tank gallons
Minimum Draintrench OR
Size
Square Feet
Square Feet
Square Feet
Square Feet
Minimum Absorption
Bed Size
,57
Square Feet
Square Feet
Square Feet
Square Feet
(a) Installation must be in accord with requirements of chapter 10D-6, FAC.
(b) A system construction permit is valid for a period of one calendar year from date of issue.
(c) Final installation inspection . nd approval is required before the system is covered. /5�
(d) Invert of stub -out for ���- to be / �/� %/P f�•� benchmark.
Invert of stub-outfor to be benchmark.
Invert of stub -out" for to be benchmark.
Invert ,of stub -out for to be benchmark.
(e) Fill quality and quantity: A
EXCAVATION MUST 8E CHECKED
BY THIS DEPARTMENT PRIOR TO
DRAINFIELD INSTALLATION.
(f) Other:IF AREA OF DRAINFIELD IS SUBJECT
TO SATURATION FROM ROOF DRAINAGE,
(ROOF MUST BE GUTTERED PRIOR TO
FINAL APPROVAL
C �j
System design and specifications by: r7�� �'7 -��� Title'J
f"
Construction authorized by: fJ �L�� Date
County°Public Health Unit
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL N0.
HRS-H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
(Stock. Number. 5744-001-4016-0) Page 1 of 2