HomeMy WebLinkAboutD O H SEWAGE DISPOSAL CONSTRUCTION PERMIT - 2-5-99n1E
APPLICATION FOR:
[ x] New System
[ ] Repair
APPLICANT:
�Jr
STATE OF FLORIDA `
DEPARTMENT OF HEALTH �ff
ONSITE SEWAGE DISPOSAL SYSTEM 1
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10U6, FAC
SO
[ ] Exist'sgG [ ] Holding Tank` [
[ ] Abaai� ment [ ] Other(Specify)
& DEBORAH YODER
AGENT:
POT ST. LUCIE PROPERTIES/AYLOR, INC.
PERMIT #
DATE PAID
FEE PAID $ ajCwf'
RECEIPT #
] Temporary/Experimental
TELEPHONE: 1-561-344-1483
MAILING ADDRESS:
P.O. BOX 650277, Vero Beach, florida 32965
TO 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]
1
,LOT: 7 BLOCK: 62 SUBDIVISION: Lakewood Park Unit 6 DATE OF 12-6-57
SUBDIVISION:
PROPERTY ID #: [Section/Township/Range/Parcel No.] ZONING:
PROPERTY SIZE,:- ACRE
11,790 Sgft 43560j PROPERTY WATER SUPPLY: [X] PRIVATE [ ] PUBLIC
• `
t-
PROPERTY STREETiADDRESS:
!' Deland Ave., Ft. Pierce, Florida
DIRECTIONS TO PROPERTY:
See attached site map
BUILDING INFORMATION [X ] RESIDENTIAL [ ] COMMERCIAL
Unit Type of No. of Building # Persons Business Activity
No Establishment Bedrooms Area Sqft Served For Commercial Only
1 1 Storyl,residence
2
3
-4
3 1626 4
is
[1] Garbage;Grinders/Disposals [ 0] Spas/Hot Tubs [0 ] Floor/Equipment Drains
[ 0] Ultra -low Volume Flush Toilets [ O] Other (Specify)
-�yAPPLICANT'S SIGNATURE: � DATE:
12-2-98
DH 4015, 10/96 (Replaces HRS-.H Form 4015 [Page 1] which may be used)
(Stock Number: 5744-061-4015-1)
Page 1 of 3
INSTRUCTIONS:
APPLICATION FOR:
Check type of permit, if "Other" specify type in blank.
V
APPLICANT:
Property owner's full name.
TELEPHONE:
Telephone number for applicant or agent.
"
AGENT:
Property owner's legally authorized representative.
MAILING ADDRESS:
P.O. box or street, city, state and zip code mailing address for applicant or agent.
LOT, BLOCK,
Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision,
al copy of the lot
SUBDIVISION:
legal description or deed must be attached.
DATE OF SUBDIVISION:
Official date of subdivision recorded in county plat books (month/day/year) or date lot originally recorded. Dividing
I I
an approved
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot.
I�
PROPERTY ID#:
27 character number for property. (Health Department may require property appraiser ID# or section/township/rant
I
/parcel number.)
PROPERTY SIZE:
Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areah
Id 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 subsurface
obstructions
may be included in calculating lot area.
I P}
WATER SUPPLY:'
Check private or public.
PROPERTY ADDRESS:
Street for For lots without an assigned street indicate street or road and locale in count
address property. address,
.
DIRECTIONS:
Provide detailed instructions to lot or attach an area map showing lot location.
BUILDING INFORMATION:
Check residential or commercial.
TYPE ESTABLISHMENT:
List type of establishment from Table II, Chapter IOD-6, FAC. Examples: single family, single wide mobile home,
restaurant,
doctor's office. II
NO. BEDROOMS:
Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations
I
R
for
occupants. I�
BUILDING AREA:
Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage she
or open or fully
+,I
screened patios or decks. Based on outside measurements for each story of structure.
# PERSONS:
fil
Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom
are
assumed.
BUSINESS ACTIVITY:
For commercial applications only. List number of employees, shifts, and hours of operation, or other information
required by
Table II, Chapter l0D-6, FAC.
iS
FIXTURES:
Mark each listed fixture with number installed or "NA" if not applicable.
SIGNATURE:
Signature of applicant or agent. Date application on day submitted to Health Department with appropriate fees a d attachments.
ATTACHMENTS:
A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimmin Lools, 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 noni1
i
sidential
establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture typ
Is, and other
features necessary to determine composition and quantity of wastewater. l