HomeMy WebLinkAboutD O H SEWAGE DISPOSAL CONSTRUCTION PERMIT 6-2-98APPLICATIONI'FOR:
[.'x ] New System
] Repair'li
STATE,;OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE-SEWAGEDISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT.
Authority: Chapter 3,81, FS & Chapter,)10106, FAC
j ]*Existing System
]'Abandonment
APPLICANT: 1.
CATHER I NE. S 1,P"'OfIS
PERMIT
DATE - PAID
FEE' PAID
RECEIPT
Holding Tank Tempbrary/Experimental
Other(Specify)
TELEPHONE:
466-7444
AGENT:
SPORT ST. LUCIE PROPERTIWAYLOR,INC.
NAILING ADDRESS:
60Q6:Andr1o,Rd.# Unit B-6,.Ft. Pierce, Florides.34451
:�Td BjE'CONPLETED BY APPLICANT -OR APPLICANT'S AUTHORIZED AGENT: 'ATTACK-BUILDINd PLAN AND TO=SCALE
SITE, PLAN- SHOWING -'PERTINENT FEATURES' REQUIRED' BY CHAPTER.--',10D-6,' FLORIDA ADMINISTRATIVE CODE.
PROPERTY 'INFORMATION -`[IF LOT IS NOT IN -A RECORDED SUBDIVISIONr ATTACH LEGAL DESCRIPTION OX DEED] --
LOT " it -BLOCK: 121 SUBDIVISION: DATE OF
14 Lakewood Park UOt 10 1-7-59
SUBDIVISION:
..PROPERTY-IDJ#: [Section/Towziship/Ran'ge/Parcel'No.] ZONING:
_P, SIZE
: E, ACRE<1SC1ftj
qfty435601 PROPERTY WATER SUPPLY:'[ X I PRIVATE; 'PVBLit�. ,,'
16,977'
PROPERTY STREET ADDRESS':
6502 Ft. WaltonAve., Ft. Pierce, Flni6da
TO PROPERTY:
See attached site maw
BUItDiNG.'.INFORMATION [,X]RESIDENTIAL COMMERCIAL
-11nit- - Type ,of, No. --of building # -Persons - . Business - Activity'
No Estabillshment Bedrooms - Area Saft Served For Commercial Only--
.1 Story, rasidoiice 3 1641 4
,2
•
.3
4
-Garbage;-Grinders/Disposals j Spas/Hot..Tubs -C; ]'Floor/ Equipment Drains
A 'd,Ultra7low Volume Flush Toilets C)]- Other (Specify)
'-APPLICANT'S "-sir. NATURE: -DATE: 6"2-98
M 4015.10 . /96_(Replabes:HRS-H.-Form 4015 [Page 1].which.maj_be'us6d) c Page 1 of 3_
(Stock Numbdr5744 _`'
- -00,1'-4015-1
INSTRUCTIONS:
APPLICATION.FOR: Check type of permit, if "Other." specify type in blank.
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. ; a
LOT„BLOCK, Lot, block,, and subdivision for lot (recorded or subdivision). If lot is not in a recorded subdivision, a copy of the lot
SUBDIVISION: legal description :or deed must be attached.
.. it
DATE OF SUBDIVISION: Official date of -subdivision recorded in county plat books (month/day/year) or date lot.originally recorded. Dividing an approved
PROPERTY IDN:
PROPERTY. SIZE:
N
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the jot.
27 character number for property:, (Health Department may require property appraiser ID# orsection/township/ragge/parcel. number.),
Net usable area•of property in acres,(square footage divided by,43,560 square• feet) exclusive of all paved a1.reas 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 subsurface obstructions ,,..
may be included in calculating lot area.
WATER SUPPLY:,. - Check private or public.
PROPERTY ADDRESS: - 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.
TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter IOD-6, FAC. Examples: single family, single wide mobile home, restaurant,
doctor's office. 1
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.,.,
/1 PERSONS:
i
I
Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are
i
assumed.
BUSINESS ACTIVITY:
For commercial applications only. List number of employees, shifts, and hours of operation, or other information required by
Table.11, Chapter 1013-6, FAC.
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 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. ,I
`r
,.For, residences, a.,,toor plan (residences) showing number of bedrooms and. building area of each unit. For nonresidential -
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.