HomeMy WebLinkAboutD O H SEWAGE DISPOSAL - CONSTRUCTION PERMIT - 9-24-97APPLICATION
[ X ] New Sys
[ ] Repair
APPLICANT:
AGENT: ,
STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $_
APPLICATION FOR CONSTRUCTION PERMIT RECEIPT
Authority: Chapter 381, FS & Chapter 1OD-6, FAC
• [ ] Existing System [ ] Hol�dir,jT 6i, [ ] Temporary/Experimental
[ ] Abandonment [ ] othler(Specify)
Y
ST. LUCIE
INC.
ii
MAILING ADDRESS:
805 E. Midway Rd., bihite City, Florida 34982
TELEPHONE: 455-1873
11---------------------------------------------------------------------- --
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
�r
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD-6, FLORIDA ADMINISTRATIVE CODE.
------------_--------------------------------------------
PROPERTY--INFPRMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: E BLOCK: SUBDIVISION: DATE OF
Mates & bounds Indian River Estates Unit 5 9-4-97
II SUBDIVISION: e
PROPERTY ID #: [Section/Township/Range/Parcel No.] ZONING:
PROPERTY SIZE:30.000 ACRES[ gft 43560] PROPERTY WATER SUPPLY: [X'-] PRIVATE [ ] PUBLIC
I
PROPERTY STREET ADDRESS:
iG White City Roast. Ft. Pierce, Florida
DIRECTIONS TO PROPERTY:
I: See attached site
BUILDING' I
Unit Type
No Esta
1 1 St
2
3
4
[ 1 ] Garbage
[ 0 ] Ultra-.
APPLICANT'S
residence
[X], RESIDENTIAL [ ] COMMERCIAL
No. of
Building
# Persons
Business Activity
Bedrooms
Area Sorft
Served
For Commercial Only
3
1247
4
i Grinders/Disposals [0 ] Spas/Hot Tubs [0 ] Floor/Equipment Drains
ow Volume Flush Toilets [0 ] Other (Specify)
SIGNATURE�,-- ��� 7 DATE: 9-22-97
HRS-H Form 4015,11 Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 3
(Stock Number: 115744-001'-4015-1)
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.
LOT, BLOCK, Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, la copy of the lot
SUBDIVISION: legal descripticut or deed must be attached.
DATE OF SUBDIVISION.:. Official date of subdivision recorded in county plat books (month/day/yea) or date lot originally recorded. Di approved Oing an appved
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot.!
PROPERTY 1D#: 7 27 character number for property. (CPIIU may require property appraiser ID # or section/township/range/l)arc"lI number.
PROPERTY SIZE: Net usable- area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas ind prepared road
beds within public rights -of way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other
11
such bodies of water. Contiguous unpaved and nonQompacted road rights -of -way and casements with no subsurface obstructions
Weary be included in calculating lot area. 1I1
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
DIRECTIONS: Provide dctailed 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 11, Chapter 1013-6, FAC. Examples: single family, single wide mobile he me, restaurant,
doctor's oftwe,
NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for
0=lpants.
BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage;
carport, exterior storage shed, or open or fully
screened patios ordecks. Based on outside measurements for each story of structure.
# PERSONS: 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 informati( h required by
Table 11, Cbapter IOD 6, FAC.
FIXTURES: Mark each listed fixture with number installed or 'NA' if not applicable.
SIGNATURE: Signature of applicant or agent. Date application one day submitted to the CPHU with appropriate fees and atttad aments.
A17ACHMENTS: A sit" plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded
easements. onsile sewage disposal system components and location, slope of property, any existing or proposed "itells, drainage
Nwures, filled areas, obstructed sreaa, and surface water. Location of wells, onsitc sewage disposal systems, sui 11fee waters, and
other pertinent facilities or features on adjacent property, if the features are with 75 feet of theapplicant lot. Lj ation 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 nonrti sidential
establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture typ"!,, and other
features nec.,.-scary to determine composition and quantity of wastewater. 1�',