HomeMy WebLinkAboutD O H SEWAGE DISPOSAL CONSTRUCTION PERMIT - 5-19-97CONSTRUCTION
E ;] Repair
APt PLICANT:
PROPERTY ST.
LOT':
PROPERTY ID
;SYSTEM MUST
REPAIR PERMI
EXPIRE ONE Y
"PERFORMANCE
BASIS FOR IS
MODIFICATION
5 Johnson
STATE OF FLORIDA a Y PERMIT
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID :711q 97.
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ inn
CONSTRUCTION PERMIT: RECEIPT,#
Authority: Chapter`381, FS & Chapter 10D-6, FAC
IT FOR:: '
[ ]-Existing System
[ ] Abandonment
ADDRESS:
-Joe: a05-7
{ ] Holding Tank [ ]. Temporary/Experimental
other(Specify)_
AGENT: & ` yo,
—BLOCK: SUBDIVISION:14
[SECTION/TOWNSHIP/RANGE/PARCEL NUMBER]
[OR TAX ID NUMBER]
•CONSTRUCTED -IN ACCORDANCE WITH-SPECIFICATIONS'AND STANDARDS OF CHAPTER 1OD-6, FAC
AND HOLDING•TANK.PERMITS-EXPI,RE=90 DAYS FROM THE DATE OF ISSUE.'ALL OTHER PERMITS
,R. FROM THE °DATE OF ISSUE. HRS APPROVAL, OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
iR.ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH ,SERVED AS A
DANCE OF THIS PERMIT,.REQUIRE THE APPLICANT TO -MODIFY THE PERMIT APPLICATION. SUCH
MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.,
SYSTEM DESIGN
AND SPECIFICATIONS
T
[GALLONS
/ GPD] EPT=IC T K/AEROBIC UNIT
CAPACITY LTI-CHAMB RED/IN
SERIES:[ ]
,A [
] [GALLONS
/ GPD]
CAPACITY MULTI-CHAMBERED/IN
SERIES:[•]
N {
] -GALLONS
GREASE INTERCEPTOR CAPACITY
[MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K - {
] GALLONS
PER"DOSE DOSING TANK CAPACITY
DOSE -RATE [ ] PER• 24 HRS , NO. OF'.PUMPS:
[ ]
R
A TYPE .SYST;
I 'CONFIGURA'
N
-F LOCATION
I • EL•EVATION
E -BOTTOM OF
L
D.
O.
T
_ H-
E
R
$PI
API
DAI
HRS-
(Stt
UARE FEET PRIMARY •DRAINFIELD SYSTEM
UARE_FEET
SYSTEM
STANDARD
:MOUND
[ ] FILLED /[ ][
] Zf )c /,I
ON:
[ ].TRENCH
I;
BENCHMARK:
G /�d Rt i'J ..
G' Aj 7,cc-dZ � G A?,* !_.�?.7' 1/F
PROPOSED,SY'STEM
SITE (
] [INCHES/FT]' [ABOVE/BELOW]-BENCHMARK/REFERENCE
POINT
FILL REQUIRED:
si�`�ill4
( ]-
�< �
INCHES.
-2�>? ��
EXCAVATION REQUIRED: [ ?Y.] INCHES.'
s3 ✓ .�it1.!' �= .s �c! saw,*,e le' _
MIX
� •`ALE f/C 6Z
,{'S
CIFICATIONS
i
BY:
TITLE:
ROVED BY:�
E ISSUED •
H Form 4016, M
ck Number; 57
TITLE: Z7_ (.
I CJ �r� -46
EXPIRATION
r 92 (Obsoletes previous editions which may -not -be used)
4-001-4016-0)
i
" APPLICANT
���� aCPHU
DATE::
Page 1 of 2
NIUw'BFR'- Permit tracking number by CPhU.
APPLICATION FOR: Cbeck type of permit; if "Other" gpecd!,ypc in blank.
AlIPLiCAN"' Property owner's full dame,
TELEPHON`E: Telephone number for applicant of agent.
&OF NT: prop#Iey legally authorized representative. ii
'
MIAILING ADDRESS:'r-'-." P.Obox or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY 1DO: 77 c'mracter ID numbu fcc properly, (CPHILImay require. property appriises- ID# or number.)
SYSTFII DESIGN AND
SPECIFICATIONS:
TAWK: Minimum specifications from Chapter IOD-6, FAC
DRAENMIAL-i3Minimum specifications from Chapt-er IOD-6, C.
0' T E ?-': littler s npeizting rerwit tequirementp, icw--wolurne Push toJets' Variance provis"),
If &sigril;J b-, i,_ r�;FisPcrcd rnus-e be sealed.
Aii'ROVE` !?Y-
C c u i ty Tvl3iac I Ieahh U ti; t C P 11 U) per a ime 1 1 e. i a'x 11 g and r, r pro -'a' t' P'i",
D ATE lr S T. I', D Date permit ii issued by CIP11U.
-in
i."Ued
di
G .1