HomeMy WebLinkAboutD O H SEWAGE TREAT - DISPOSAL SYSTEM APP - CONSTRUCT PERMIT - 4-13-00oFTN�__ F
STATE OF FLORIDA
PERMIT
DEPARTMENT OF HEALTH
DATE PAID
.
ONSITE SEWAGE DISPOSAL SYSTEM
FEE PAID-
�.
APPLICATION FOR CONSTRUCTION PERMIT
RECEIPT.#
WE
Authority: Chapter 381, FS &
Chapter 1OD-6,
FAC
APPLICATION FOR:
[ X] New System
[ ] Existing System [ ]
Holding Tank
[ ]:Temporary/Experimental
Repair
Abandonment
Other(Specify)
APPLICANT :
TELEPHONE:
W 1 LL
1 AM SUNDERLAND, SR.
• 466-5096 Y
AGENT: PORT ST. LUCIE PROPERTIES/AYLOR, INC.
MAILING ADDRESS:
4640 Christensen Rd., White City, Florida NO 34981
_______________________________________________________________3=
TO BE COMPLETED BY APPLICANT OR APPLICANT'S.AUTHORIZED AGENT. ATTACH, BUILDING PLAN AMD TO -SCALE
SITE PLAN SHOWING•PERT.INENT FEATURES REQUIRED BY CHAPTER,10D-6, FLORIDA ADMINISTRATIVE,;CPDE.
__'-------------------- _ ___________________________________=___==..
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: f4ETES"&' BLOCK: SUBDIVISION: DATE OF
BOUNDS SHEENS PLAT OF WHITE CITY SUBDIVISION: 1923.....,,,
PROPERTY ID #: [Section/Township/Range/Parcel No.] ZONING:
PROPERTY. SIZE ACRES S f 1C 3560] PROPERTY WATER SUPPLY: [] PRIVATE [ ] PUBLIC
.120,193 _
PROPERTY STREET ADDRESS
a
DIRECTIONS TO PROPERTY4'+f,
1
BUILDING INFO
Unit Type of
No Establi
1- 1 Story
2
3
4
Christensen Road, White City, Florida
attached site snap
MATION [k ] RESIDENTIAL [ ] COMMERCIAL
No. of Building # Persons Business Activity
hme'nt Bedrooms Area Saft Served For Commercial Only
esidence 3 1217 4
[1 ] Garbage Grinder's/Disposals [0 ] Spas/Hot Tubs [p ] Floor/Equipment Drains
] Ultra -lord Volume Flush, Toilets [ 01 Other (Specify) ,
APPLICANT'S SIGNATURE: DATE: 4-13-00
DH 4015, 10196 (Replaces HRS-H Form 4015 [Page 1) which may be used) • • Page 1 Of 3
(Stock Number: 5744-001 4015-1)