HomeMy WebLinkAboutD O H SEWAGE TREAT - DISPOSAL SYSTEM CONSTRUCT PERMIT - 4-19-20005•tAhJ80a fit, i
STATE OF , FLORIDA PERMIT NO.
IDD
` iDEPARTMENT OF"HEALTH DATE PAID
ONSITE -SEWAGE �tREATMENT AND DISPOSAL SYSTE14 FEE PAID:
.>,.•s.RECEIPT #:
CONSTRUCTION.`'ikM'IT
CON 7E CTION PERMIT FOR:
New Syst [ ] Existing System [ .] Holding Tank [ ] Innovative
[ ] Repair' f [ �i]y Abandonment [ ] Temporary [ ]
APPLICANT: U
PROPERTY ADDRESS: C,! I%`
LOT: r BLOCK: SUBDIVISION: �w y
[SECTION, TOWNSHI , RANGE, PARC NUMBER]
PROPERTY ID #: _ [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065;
F.S.,. * CHAPTER 64E-6•, F.A.'&.' DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE .PERMIT APPLICATION.
SUCH MODIFICATION& MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID., ISSUANCE OF THIS PERMIT
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED FOR MEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ ] GALLON GgD SEPTIC T a�vnnrn r„aTm nnvnnrmv LTL-CHAMBERE
,A [ ] GALLONS / GPD CAPACITY MULTI-CHAMBERED/IN-SERIES [ ]
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ]
D [.?� ] SQUARE FEET PRIMARY `DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM I [ ] STANARD [ ] FILLED
I CONFIGURATION: [ ] TRENCH 7C1BED []
N j
F LOCATION OF BENCHMARK: _n - (Y.! -h ( V n C' ` • ' f l % �
I ELEVATION OF PROPOSED SYSTEM S
E BOTTOM OF DRAINFIELD TO BE
L
D FILL REQUIRED: [ _ ] INCHES
O
T
H
E
R
SPECIFICATI
APPROVED BY:
DATE ISSUED:
DH 4016, 12/g991 (Page 1)
] [INCHES/*T [ABOVE/BELOW] BENCHMARK/REFERENCE POINT
[ ] INCH /-PrFI (BBB6W] �NCHMARK
EXCAVATION REQUIRED: [] INCHES
TITLE: f u �� � �L(' d' 1-
ITLE: CHD
EXPIRATION DATE
(Previous Editions May Be Used)
pt. 1: Health Department
pt. 2: Applicant
pt. 3: Installer/Contractor
pt. 4: Building Department
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