HomeMy WebLinkAboutD O H SEWAGE DISPOSAL - CONSTRUCTION PERMIT 10-8-97 - SEPTIC TANKTba al o 1 spa, M 1 18 56) r)
STATE OF FLORIDA- _PERMIT # `7 I la
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES. DATE PAID- •_.f3 %r�� 7 `
ONSI.TE SEWAGE DISPOSAL SYSTEM FEE PAID $ S® CD.
CONSTRUCTION PERMIT.RECEIPT'#
Authority: Chapter-381, FS & Chapter 1OD-6, FAC
CONSTRUCTION ;PERMIT FOR:
LveNi New System [ ] Existing System [ ] Holding Tank [ ] Temporary/Experimental
[ _] Repair [Y ] Abandonment [ ] Other(Specify)
APPLICANT: 6,480919 SH IN-Y AGENT: 4 yL0 2 OOPS L 490 P
PROPERTY STREET ADDRESS:
NN V L 41\1 L• L .
4°4
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LOT: I BLOCK: a SUBDIVISION: L j Ajd 0 44,�
PROPERTY ID #j: [SECTION/TOWNSHIP/RANGE/PARCEL NUMBER] ny
(OR TAX ID NUMBER]
SYSTEM MUST-BE,CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS`OF CHAPTER 1OD-6, FAC
REPAIR PERMITS•AND HOLDING TANK PERMITS EXPIRE 90 DAYS -FROM THE'DATE OF ISSUE. ALL OTHER PERMITS"
EXPIRE ONE YEIIIR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FIIIIOR"ANY SPEC.IFIC'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 APPLICATION. SUCH
MODIFICATIONS �MAY RESULT I.N THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DESIGW AND SPECIFICATIONS
T [ e-i J ALLONS /_GPD] SEPTI�/AEROBIC UNIT CAPACITY iMULTI-CHAMBERED,IN SERIES:[700
J
A [" ] [GALLONS / GPD] CAPACITY �MULT_=CCHAMB^BRED/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: [ ]
i
D ( 16S1 ] SQUARE -FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
i
A TYPE SYSTEM: _ [ ] STANDARD [ J FILLED [] MOUND. [
I CONFIGURATION: A ]. "TRENCH BED [] ����
N 4�
F LOCATION 0
I -+ELEVATI.ON
E ' BOTTOM 'OF
L
D : 'FILL REQUI
0 V
T A
H
E
R
BENCHMARK: - r/L e) A AiWAJ.V-
PROPOSED SYSTEM.: SITE [ t� ]- NCHES',FTJ ABOVE+/BELOW] NCHMATRK- EFERENCE POINT" "
ATNFIELD. TO BE [ e ] ['IkTC ErS FT] [ABOVE:/BELOW] BE CHMARiC`/^REFERENCE POINT
D: ',[ �/� GJ ) -,1N;CH+ES t� EXCAVATION REQUIRED: INCHES
S Tu!' 0U
SPECIFICATIONSi BY:� TITLE:
s
APPROVED BY: E. 'TITLE:
HATE ISSUED: �.
HRS-H Form_ 4016., Mar 92.(Obsoletes.previous editions which may not.be used)
(Stock Number: 5744-001-4016-0)
CPHU
` EXPIRATION'DATE:
Page 1 of'2.,
APPI If .Ar\IT
INSTRUCTIONS:
'i 5
PERMIT NUMBER:
Permit tracking number by CPHU.
' c3
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APPLICATION FOR--
Check type of permit; i; "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 A`i>WESS:
Pi). box or street mailing; address for applicant or agent.
LOT, BLGgX',`SUBDIVISION or
;
PROPERTY IW:
27 character ID number for property. (CPHU may require property appraiser ID# or sectionitownship/ra
%elparccl number.)
SYSTEM DESIGN AND
SPECIFICATIONS-.
TANK:
Minimum specifications from Chapter IOD-6, FAC.
i
DRAINFIELD:
Minimum specifications from Chapter IOD-6, FAC.
OTHER:
tither specifications, such as operating permit requirements, low -volume flush toilets, variance provisos.
'
SPECIFICATIONS BY:
Name of individual providing specifications. If designed by a registered engineer roust be scaled.
I
APPROVED BY:
County Public Health Unit (CPHU3) personr_el reviewing and approving permit.
1
DATE ISSUED:
-
Date permit is issued by C;PIIU3,
EXPIRATION DATE:
One year froin date ir-sucd if the systems has not beets inctarll� d: Permits far system repairs become void 9
Jays from the
date issued.
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