HomeMy WebLinkAboutD O H SEWAGE DISPOSAL - CONSTRUCTION PERMIT - 5-8-00 - SEPTIC TANKSTATE OF FLORIDA t 1 Ci a)l
;DEPARTMENT OF HEALTH
1Oy?SITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
(CONSTRUCTION PERMIT
C(�RMIT FOR:
t�� �'��•+r ~�+* [ ] Existing System
[ ] Repair [ ] Abandonment
APPLICANT:
( ] Holding Tank
[ ] Temporary
PERMIT NO. V ��
DATE PAID:
FEE PAID:
RECEIPT #:
Innovative
PROPERTY ADDRESS: f�a'ti/�-1 tll� ►" 1 C%C
LOT:�t BLOCK: SUBDIVISION: � -A !iCi Ev.{�� �
[SECTION, TOWNSHIP,..RANGE., .•PARCEL NM6ER]
PROPERTY ID # : ` _ [OR TAX ID NUMBER]
SYSTEM MCTST BE. CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF -SECTION 381.0065',
F.S., AND CHAP ITER 64E-6,. F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE •SAFTISFACTORY
PERFORMANCE FOR -,ANY 'SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH -SERVED AS.,A:,,
BASIS FOR ISSUANCE OF THIS PERMIT,,REQUIRE' THE APPLICANT TO MODIFY THE .PERMIT•' A?PLICATION.
SUCH MODIFICATIONS MAY•;RESULT'IN'THIS PERMIT BEING MADE NULL AND VOID'. ISSUANCE- OF THIS..PERMIT
DOES NOT -EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER . FEDERAL ; STATE, OR LOCAL PERMITTING
REQUIRED FOR DEVELOPMENT,OF•THIS.PROPERTY..
SYSTEM DESIGN AND SPECIFICATIONS' ;
T
(qCD ] / I'm 'SIC TA�IA-CHAMBEREIy
- ]
A
[ ] GALLONS / GPD., CAPACITY MULTI-CHAMBERED/IN-SERIES
N
[ ] GALLONS GREASE INTERCEPTOR CAPACITY',' [MAXIMUM CAPACITY SINGLE TANK:'1250 GALLONS]
K
[ ] GALLONS DOSING -TANK CAPACITY [''. ] GALLONS @ [ ]. ,DOSES PER 24. HRS '. # PUMPS
D
L-] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
;
Et
L ] SQUARE FEET SYSTEM
A TYPE SYSTEM: L l STANARD O
[ ]
I CONFIGURATION: [ ] TRENCH .[ ]_
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE .[ ] /F1]
2CHE
/B•ELOWj /REFE11 RENCE POINT i
E4 BOTTOM OF DRAINFIELD `TO BE' [ A. ] TJ
ELOW CHMAR. EFERENCE' .POINT
D" .ILL REQUIRED:�y[ _ ] INCHES EXCAVATION.REQUIRED:
[ ]; INCHES/y 1
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SPECIFICATIONS�B Vb2�2 --�"' ''lU
TITLE:
'
��•�J
3PPROVED
BY: f .�C.TITLE:
�1 CHD
i
)ATE ISSUED: �� 1��
;` f c)/2�1
EXPIRATION DATE:
)H
4016, 12/99 (Page 1) (Previous.Editions May Be Used)
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Page 1 of 3
pt. 1: Health Department
pt. 2. Applicant
i
pt. 3:Installer/Contractor
pt. 4: Building Department