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HomeMy WebLinkAboutD O H SEWAGE DISPOSAL CONSTRUCTION PERMITFLORIDA f PERMIT :,f` ~lf T i.OF $EALTH ' r DATE PAID F : LOCATION. -OF ;BE I ELEVATION't OF...P E '"'BOTTOM. OF DRA I L PE D FILL REQU%RED. O �� L� Vr • � T: > H _ E a.. R'�� (FT] [ABO E BELO :j _REFERENCE (FTj ,. OifBEL'OW ENC /REFERENCE POINT :QUIRED [ � ] INCHES PL%�:Al!ID��'hf OR s F� �',••�ii&t►�`Sp � ;bin STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ i o nc) APPLICATION•FOR CONSTRUCTION PERMIT RECEIP if Authority: Chapter 381, FS A Chapter 1OD-6, FAC [ j Existing System [ J Holding Tank [ ] Abandonment [ ] Other(Specify) _ATRICE BURNS •='t . fQRT 'ST. LUC I E PROPERTIES/AYLOR, INC. p[a ,MJ''ADDRESS: 2388 N.N. 55TH. TERR., MIAMI, Florida 33142 i ] Temporary/Experimental �I TELEPHONE: 305-634-0497 D BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO-SCALI ING PERTINENT FEATURFA REQUIRED BY CHAPTER 1OD-6, FLORIDA ADMINISTRATIVE CODE. ------------------ i" 61Ptiii'.'Y�NFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED )1ETES BLOCK: SUBDIVISION: - DATE OF ,t MOUNDS •; -SUBDIVISION:_ f [Sec on/Towns ip/Range/Parce No., ONI ,e '4...qr ;' tee; •', •l � PUBLI ,1 ACRES Sqf 43560] PROPERTY WATER SUPPLY: [ x] PRIVATE [ J 20,100 +i.©pi$T1t 0TREE'3'. ADDRESS: Avenue Q. Ft. Pierce, Florida - �S. DItECQNB TO 'PROPERTY: map -.. _ See attached site ' s COMMERCIAL OiJZLDim, INFOEtDQATION [ X ] RESIDENTIAL [ ] r Wilt :.,.Type 'qf No. of Building # Persons Business Activity Only ' jstablIshment Bedrooms Area Saft Served For Commercial 1' 1 •,Sfor,:y-•, res i sdence _ 4 lY995 4 pM. �' it .. .. ' •• 4 ag,rbage Grinders/Disposals [ 0] Spas/Hot Tubs [ ] Floor/Equipment Draii Vltra=lp�v.•Volume Flush Toilets [ 0] other (Specify). - APP'LICANT',S. SIGN7ITUR DATE: 12-3-98 CHANGED HOUSE 11 may be used) page 1 of DH 4015;:1olgti (Replaces.HR,$-H Form 4015 jPage which (Stock Number.'•5744-Dal=4015-1) i