HomeMy WebLinkAboutD O H SEWAGE DISPOSAL - CONSTRUCTION PERMIT - 5-9-00•
dE STA TE 'OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM.
'APPLICATION F,OR;CONSTRUCTION PERMIT
0
Authority:., Chapter 381, FS & Chapter 1OD-6, FAC
wv.
YPtICAtION FOR:
1-40
PERMIT # Sc_ n,�? lcl.�
DATE PAID
FEE PAID $
RECEIPT #
XX] New System Existing System Holding Tank Temporary/Experimental
Repair 4. Abandonment Other(Specify)
PPLICANT: TELEPHONE:
PETE HOLLAND' -464.;-3776
:GENT:
'-PORT -ST.: ..LUC I E PROPER SAYI_QkINC
AILING Ab6iESS�
.3902- Avrintje'L, Ft. Pleirce, Florida 34947 in,
- - - - - - - - - -
- - - - - - - - - - - -
'0 BE COMPLETk)�.. g,Y' APPL iC AN, t, 'OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING . E' PLAN AND TO-SCAL
ITE PLAN-SH.OWIN.G-.,PE.RTINENT"FEATURES-REQUIRED BY CHAPTER 1OD-6, FLORIDA ADMINISTRATIVE CODE.-:--
ROPERTY INFORMATION '[IF-LdT`IS NOT IN A RECORDED SUBDIVISION,,ATTACH LEGAL-DESCRI . PTION,O . R-DEED.]
OT: Lbt 18"i JLOCK: V. SUBDIVISION: DATE OF
E1/2 Lot 19 Sunland Gardens 9-6-47.
2� SUBDIVISION:-
ROPERTY ID-,*#: [Section/Township/Range/Parcel, No.]. •ZONING*
ROPERTY SIZE: 12 069;'' AdkES.'* qjf'.4"3560] PROPERTY WATER SUPPLY: PRIVATgf, f X ]".PUBLIC
ROPERTY STREETI'AbDRESS:'
Avenue 14, Fi'. Pierce, Florida
IRECTIONS TO PROPERTY -
See i ttfldhed site iflap,
UILDING.-INFORMATION xRESIDENTIALL COMMERCIAL�
nit Type of No. of Building # Person-s Busines's Activity,
o Establishment' "Bedrooms Area Soft Served For Commercial Only
I Story res Ildence '13 1406 4
is
IJIJ
1 ]'Garb6ge'Geilnders/DisptsalIsI 'I [ o ] SpAs/Hot Tubs . (0 Floor/Equipmen',Drains
0-j Ultra -low Volume Flush
Toiletk
[o ] Other (Specify)
?PhICANT 'S SIGNkTURE: DATE: 4-13-00
H 4015. 10/96 (Replaces HRS-H Form 4015 [Page 1] which may be used) Page 1 of 3
Mock Number: 5744-001-4015-1)