HomeMy WebLinkAboutD O H CONSTRUCTION PERMITT/ V
STATE OF FLORIDA PERMIT. # 06
DEPARTMENT OF HEALTH AND REHABILITATTlii�,- ItVICES DATE PAID b7— S1-
ONSITE'SEWAGE DISPOSAL SYSTEM FEE PAID $
CONSTRUcTION PERMIT RECEIPT # 006 i W
Authority: .Chapter 381, FS & Chapter 1OD-6, FAC AAy
CONSTRUCTION PERMIT FOR:
[ V New System [` j Existing System `[` "];Holding Tank `' [ ] Temporary/Experimental
[ ] Repair [ ] Abandonment [ ] Other(Specify)
APPLICANT:, �' AGENT: 9 e
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PROPERTY STREET ADDRESS C A iy /r llz2s,®s ,s .,,7 /),j, - .j
LOT. 6 - BLOCK:' SUBDIVISION: �,/rl
PROPERTY ID #: "'-"[SECTIONG/TOWNSHIP/RANGE/PARCEL NUMBER]
[OR TAX ID NUMBER] Ll
TEM MUST"BE"CONSTRUCTED IN''ACCORDANCE WITH"SPECIFI'CATIONS-AND STANDARDS OF .CHAPTER.10D-6,'FAC
AIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
.IsIRE'ONE'YEAR FROM THE DATE'OF ISSUE. HRS"APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
Fr;,]tFORMANCE FOR -ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL.FACTS.WHICH SERVED AS A
BASIS FOR ISSUANCE OF 'THIS PERMIT, REQUIRE THEAPPLICANT TO MODIFY THE PERMIT APPLICATION.' SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL'AND,VOID. ri
SYSTEM DESIGN AND SPECIFICATIONS _ BY
S Lucie County
T [ 1(�] [rGALLONS '/ GPD SEPTIC TANK/ 'EROBIC' UNIT CAPACITY MULTI-CHAMBERED/I SERIES: [
A [ ] [G'" ONS / GPD] CAPACITY MU TI-CHAMB°ZREDy-fN SERIES:(.]
N' [ ] GALLONS -GREASE-_INTERCEPTOR•CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS)
K [ ] GALLONS PER DOSE DQS—NG91TANK_,Q.PACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
D [ e ] SQUARE FEET PRIM rRYDRA•ZN-FI-ELxD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM:' [ ) STANDARD ( ] FILLED MOUND [ ]_
I CONFIGURATION: [ �,] TRENCH [ ] BED
N
F LOCATION OF BENCHMARK:, ffo/v���t'C�/s✓`
I' ELEVATION OF PROPOSED SYSTEM SITE [ ] t['INCHES/FT] ABOVE ELOW] B'E cHMARK/REFERENCE POINT
E BOTTOM OF' DRAINFIELD TO BE [ /z ] [�' CHES FT] [/BELOW ..]BENCHMA REFERENCE POINT
L
D FILL REQUIRED:' [- ] INCHES, EXCAVATION REQUIR®ED: [ W(f) INCHES
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.,.e.��r�r� n �r rI1R1�T T(1
R i N ur unruiv ��..� �....,,..._-.
SPECIFICATIONS BY: TITLE: ROOF MUST BE GUTTERED PRIOR TO
� N.A.1 l�PPR9vQ�
APPROVED, BY: TITLE: d CPHU
DATE ISSUED �9 EXPIRATION DATE:
r r IF AREA OF DRAINFIELD IS SUBJECT TO r
SATURATION .FROM ROOF DRAINAGE,
HRS-H "Form 4016, Mar 92 (obsoletes previous editions which,may not be uMOF_MUST .BE GUTTERED PRIOR TO Page 1 of 2
(Stock Number: 5744-001-40.16-0) FINAL APPROVAL.
APPLICANT
INSTRUCTIONS- S \
PERMIT NUMBER: Permit tracking number assigned by CC1'1-IU.
APPLICATION FOR: Check type of permit, if "Other" specify type in blank. 4
APPLICANT: Property owner's full name.
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TELEPHONE: Telephone number for applicant or agent.
II
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AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
N
LOT, BLOCK, SUBDIVISION or
PROPERTY IDH: 27 character id number for property. (CPHU may require property appraiser ID 11 or section/township/range/paredi number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 1013-6, FAC.
I'
DRAINFIELD: Minimum specifications from Chapter 1013-6, FAC.
OTHER: Other specifications, such as operating permit requirements, low -volume flush toilets, variance provisos.
�I
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
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APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CPHU. II
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days frofthe date
issued:
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L� III
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