HomeMy WebLinkAboutD O H SEWAGE DISPOSAL PERMITs
I ,
I
Application /.Permit
No.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DIVISION OF HEALTH
Post Office Box 210, Jacksonville, Florida 32201
APPLICATION AND PERMIT
OF
INDIVIDUAL SEWAGE DISPOSAL FACILITIES
SAINT LUCIE County Health Department
Section I - Instructions:
�1. Percolation test data, soil profile and water table ele-
vation information must be attached. (Note: Test
must be made at proposed location of system).
2. Existing! building and proposed buildings on lot must
be shown and drawn to scale at their location or
proposed location. (Use block on this sheet or attach
plot plan).'
3. Proposed location of septic tank must be. 'shown on
plan.
4. Any pond or stream areas must be indicated on the
plan.
Section II - Information:
5. Indicate name and date of plat of subdivision. If not
platted, attach metes and bounds description.
6. Complete the following information section.
NOTES:
1., Not valid if sewer is available.
2. Individual well must be 75 feet from any part of
system.
3. •call L?,OL���11 and give this
office a 24-hour notice when ready for inspection.
1501 FT w,. i 01%./ '4V&
1. Property Address (Street & House No.) S 61 Lorne
Lot 16. Block 67 Subdivision
Date Platted' 1957 Directions to Job U
2• Owner or Builder _I'lr• FICCOrtis Pensacni n
P. 0. Address city Fto Piereeg Fla.
Septic tank system to be installed by:
Scale 1SCANNED" = 50' BY
(Rear) _C* ,
THIS PERMIT EXPIMS M
3. Specifications:
YEAR EEO 9])ATEQ5 %M.E
—!;I nr% gallon tank with
square feet of
m
drainfield with at least 4" inside diameter pipe.
m
Permit VOID if well or septic
S
4. House-fo be constructed:
w
system is installed in a location
Check one: FHA VA
Conventional
o v
other than area permitted.
HEALTH DEPARTMENT
� R
o
PRIOR
REQUIRED
" o
This is to certify that the project described in this
d
APPROVAL
v,
application, and as detailed by the plans and speci-
DRAINFIELD TO BE INSTALLED.
`0
ficatioris and attachments will be constructed in ac-
o
WITHIN THE SP-ECIFJEI) MED]
o
a
cordance with state requirements.
AREA.
Applicant: fir. MCCCrtB
c9L4D irq
Please Print
(Front)
(Name of Street or State Road)
Signature: c
Date:
�2yL��IJ�
+ * + * + • + » ZI DO NOT WRITE BELOW THIS LINE * * * * * * + • * »
Section.111 - Application Approval & Construction Authorization
,
The above signed application has been found to be in compliance with Chapter 1OD-6, Florida Administrative Code,.
and nstr Ion Is hereby approved, subject to the above -specifications and conditions.
By:11, County Health Dept. ,�t�; Si_ Date Li Z�1i�
Y N Y Y 11 % M % M % % % % % %.. % % ♦ ♦ ; Y; % N N N % N N % % % % N % Y i i % N Y
Section IV - Final Construction Approval
Construction of installation approved: Yes ,- No
Date: By:
FHA No. VA No.
Y Y% Y i♦ Y i tl Y Y'' N N N Y%%%%% M %,- % Y Y% Y Y% N% N i N N♦ Y%%
SAN 428
REV. 3/75
ierc
t.- :.