HomeMy WebLinkAboutD O H SEWAGE DISPOSAL CONSTRUCTION PERMIT - 6-19-98STATE OF PLORIDA PERMIT
DEPARTMENT OF HEALTH DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID
CONSTRUCTION PERMIT RECEIPT #
Authority: 'chapter- 381, flS &,Chapter 101176, 'FAC
'PERMIT FOR:
4
New System Existing System [ ]'.Holding,Tank j Tempbrary/Experimental
Repair;lt -f Abanddnm'ent, Other(Specify)
APPLICANT: ,,4 6 70 6'Q N C `.5 j M M 0 N -S AGENT:.
PS
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PROPERTY STREET' ADDRESS: rOgT Ljxrolv
LOT: BLOCK: SUBDIVISION'::
PROPERTY IDI:
[SECTION/,TOWNSHIP/RANGE/PARCEL NUMBER]
[OR -TAX ID NUMBER)
SYSTEM MUST0. BE CONSTRUCTED -IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS, OF CHAPTER 10D-6,
FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE.90,DAYS FROM THE DATE OF ISSUE. ALL OTHER
PERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH APPROVAL OF SYSTEM DOES '
NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. -ANY CHANGE IN MATERIAL:
FACTS WHICH�l SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT REQUIRE THE APPLICANT TO MODIFY THE
PERMIT APPLICATION. 'SUCH MODIFICATIONS MAY RESULTIN THIS PERMIT BEING MADE NULL AND VOID.'
,SYSTEM DES16NAND SPECIFICATIONS
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K 'D ZaEROBIC UNIT CAPACITY M1JIT_ZzQHWBERE N SERIES:[
T GPD) (S-E - �C TAN
A j ],IJGALLONS 1, 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:
D SQUARE FEET PRIMARY DRAINFIELD SYSTEM.
R �SQUARE FEET !SYSTEM
'A TYPE SYSTEM, STANDARD FILLED G"PMOU,� ,D,.X/ 1,
I CONFIGURATION: TRENCH BED
N
F LOCATION bF BENCHMARK. or xiv /L5 ic c 7 F T L TQ� or zr5 i fade D
I ELEVATION OF PROPOSED SYSTEM SITE [ ztf�UBS FT] 'BOVVE BELOW f<BJE4GHMXPJKjREFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE ¢ FT] 'j-ABOVE7BELOW]6C#*ARj /"REFERENCE POINT
D FILL R
aNv
0 - -
T
H
E,
R.
SPECIFICA
APPROVED BY
D:INCHESIHE.S EXCAVATION REQUIRED:' INCHES
,0 F S I . LtS01-17- Actsi 18" 46ou'c TOC'
I t, 0 - - _� -- �_-C -
NS BY: TITLE,
'TITLE:
DATE ISSUED-V�
11i,
DH 4016,10/96
(Stock Number:
Form 4016 [page 1] which may be used)
.Applicant
CHD
b-5
EXPIRATION DATE:
Page I of 2
INSTRUCTIONS:
PERMIT NUMBER:
APPLICATION FOR:
APPLICANT:
TELEPHONE:
AGENT:
MAILING ADDRESS
Permit tracking number by County Health Department.
Check type of permit; if "Other" specify type in blank.
Property owner's full name.
m
Telephone number for applicant or agent.
Property owner's legally authorized representative.
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pia
P.O. box or street mailing address for applicant or agent.
I
LOT, BLOCK, SUBDIVISION or
PROPERTY ID#: 27 character ID number for property. (Health Department may require property appraiser ID# or I;;
section/township/range/parcel number.) It
SYSTEM DESIGN AND
SPECIFICATIONS:
i�
TANK: Minimum specifications from Chapter IOD-6, FAC.
I;
DRAINFIELD: Minimum specifications from Chapter IOD-6, FAC. ;I
,l
OTHER: Other specifications, such as operating permit requirements, low -volume flush toilets, variance provisos,;,
� If
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed_ I?
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i
APPROVED BY: County Health Department personnel reviewing and approving permit.
' lit
DATE ISSUED: Date permit is issued by County Health Department. �Il
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EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 9�0 days from the
date issued. I�p
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