HomeMy WebLinkAboutD O H SEWAGE DISPOSAL CONSTRUCTION PERMIT - 1-10-96.STATE OF FLORIDA PERMIT # ���✓�
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID�U-
�" ONSITE SEWAGE `DISPOSAL SYSTEM FEE PAID
`-� APPLICATION FOR CONSTRUCTION PERMIT RECEIPT #
Authority: Chaptere181, FS & Chapter 10D-6, FAC
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APPLICATIONjFOR:
[ X ] New Sy 'tem
[ ] Repair
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?APPLICANT:
WILLIE BRADLEY
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AGENT:
PART ST.
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MAILING ADDRESS:
[ ] Existing System
[ ] Abandonment
AYLOR.
[ ] Holding Tank
[ ] Other(Specify),
1�14 12-12g
ar 60-0)(7-:S i
2701 Essex Ct.. Ft. Pierce. Florida
[ ] Temporary/Experimental
TELEPHONE:
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T0 BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN'SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD-6, FLORIDA'ADMINISTRATIVE CODE.
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PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
N21 of 17
LOT: All of 18 BLOCK: SUBDIVISION: DATE OF
S23® of 1 „ 28 SAN LUCIE PLAZA SUBDIVISION #1 OCT. 1925
SUBDIVISION.
PROPERTY _ID I [Section/Township/Range/Parcel No.] ZONING:
PROPERTY WATER SUPPLY: PRIVATE PUBLIC
PROPERTY SIZE: ACRES �[Sgft 3560] [ X] [ ]
10,500
PROPERTY STREET ADDRESS:
I Navaio Ave.. Ft. Pierce. Florida
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establ lshmei
1 i
1 Story reside
2
4
See attached site mao
[ X ] RESIDENTIAL [ ] COMMERCIAL
No. of Building # Persons
Bedrooms Area Saft Served
3 1644 4
Bus ness Activity
For Commercial Only
[ 1] Garbage Grinders/Disposals [ 0] Spas/Hot Tubs [0 ] Floor/Equipment Drains
[0] Ultra-lo Volume Flush Toilets [ 0] Other (Specify)
APPL I CANT' S SIGNATURE, Q + DATE: 1-5-96
HRS-H Form 4015, Mar 92 (obsoletes previous editions which may not be used) Page 1 of 3
.(Stock Number: 5744-001-4015-1)
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INSTRUCTIONS:
APPLICATION FOR:
APPLICANT:
TELEPHONE:
AGENT:
MAILING ADDRESS:
LOT, BLOCK,
SUBDIVISION:
DATE OF SUBDIVISION
PROPERTY ID#:
PROPERTY SIZE:
WATER SUPPLY:
PROPERTY ADDRESS:
Check type of permit, if "Other" specify type in blank.
Property owner's full name.
Telephone number for applicant or agent.
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Property owner's legally authorized representative.
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P.O. box or street, city, state and zip code mailing address for applicant or agent.
Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a'copy of the lot
legal description or deed must be attached.
Official date of subdivision recorded in county plat books (month/day/year) or date lot originally recorded. Dividing an approved
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot.!.
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27 character number for property. (CPHU may require property appraiser ID # or section/township/range/parcel number.
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Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas and prepared road
beds within public rights -of way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other
such bodies of water. Contiguous unpaved and noncompacted road rights -of -way and easements with no subsurf4pe obstructions
may be included in calculating lot area.
Check private or public.
Street address for property. For lots without an assigned street address, indicate street or road and locale in county.
DIRECTIONS:
Provide detailed instructions to lot or attach an area map showing lot location.
BUILDING INFORMATION:
Check residential or commercial.
TY;k"LSTABLISHMENT:
List type of establishment from Table II, Chapter IOD-6, FAC. Examples: single family, single wide mobile home, restaurant,
doctor's office.
NO. BEDROOMS:
Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for
occupants.
BUILDING AREA:
Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully
screened patios or decks. Based on outside measurements for each story of structure.
# PERSONS:
Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are
assumed.
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BUSINESS ACTIVITY: For commercial applications only. List number of employees, shifts, and hours of operation, or other informatiian required by
Table II, Chapter IOD-6, FAC.
FIXTURES: Mark each listed fixture with number installed or "NA" if not applicable.
SIGNATURE: Signature of applicant or agent. Date application one day submitted to the CPHU with appropriate fees and attachments.
ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming, pools, recorded
easements, onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage
features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and
other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any
public well within 200 feet of lot.
For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For ront�sidential
establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other
features necessary to determine composition and quantity of wastewater.
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