HomeMy WebLinkAboutD O H SEWAGE DISPOSALFAA
ST.LUC;)ECounty Health Denartment
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ,
DIVISION OF HEALTH
Application and Permit of
Individual Sewage Disposal Facilities ,
ration I - Instructions:
k''.• Percolation test data, soil pro-
fil' and water table elevation
::,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_`'Pibposed location of septic
,.:
tank must be shown on plan..
4R1; Any: pond or stream areas must
A�, be..indicated on the ,plan.
`Section II - Information:
5. Indicate name and date of
recording of subdivision. If
not recorded, attach metes and
bounds description. r
6. Complete the following infor-
mation section.
Notes:
1. Not valid if sewer is available.
2. Individual well must be 75 feet ,
from any part of system.
3. Call 461-5350 and give
this office a 24'-hour notice
when ready for inspection.
Property Address (Street & House No.)
Lot —` Block Subdivision -S%'
- C 3 7- 3f'
::-, .. Date Recorded Directions to Job i
- i l xi nF c i
"X7. .
�k ; 4f r -
.., i`27
4'=E l�"` %^a /='t-�L'',� /i Sr T'e`^'/i�o'�?�.
aF�
1 .�=/.C'.:c'�V.Z
Owner, or Builder
-1 . P. Addressd /wr, 13y 1�/ CityG'?
u3: Specifications
{. - ,! • Tank• Drainfield
Scale 1" = 50'
:» ;;.•' i `' Gals.. ft..of 16" clay tile
or 5".perforated I(Rear)
`..y plastic drain in a
3' trench or
3Qa
z
z
hd0" ft. of 4" clay drain
Gals;
SEE ATTACHED
"
' a or 4"'perforated
a �� Lstic drain in an
I°,h
THIS PERMIT EXPIRES ONE (I)
°�
',.; ;; _- 8" trench
YEAR FROM DATE OF ISSUANCE .
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•
9. House ;to be constructed:
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Check. one: FHA
NP.
Permit VOID if well or septic
m (0
VA [/ Conventional
rr
system is installed in a location
w rt
0
other than area permitted.
�ro
PRIOR HEALTH DEPARTMENT
This is to certify that the project
APPROVAL REQ-
described, in this application, and as
rt
rt
detailed'�by the plans and.specifica-
m
TO BE INSTALLED
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Lions and attachments will be con-
DRAINFIELD
SPECIFIED FILLED
w
ri> '!structed in accordance with. state
WITHIN THE
requirements
v
AREA. r�>erTr; $k
• -
S ANNED
Applicant: D-
(Front)
' •Please -Print .�
(Name of Street or
State Road)
St Lucie Count
Az/_
Si attire
.Date r`
"• *.*'.* -*"* * �* * * * * * * * * DO Noe WRITE
BELOW -THIS; LINE * *�* •
'� * • • • •
• • •
j L'Section.III - Application Approval & Construction Authorization
' Installation subject to following spec idl.conditions:
The q e siign a p is tion has been found to be in compliance with Cha er 1```7��J-13,
Floc da Admin tr t' a ode, and constricEion is her �fiy ap owed. subject tones/�
abo itions. /
By; County Health Dept. Date
'Section •Final Construction Ar ruvai
Construction of installation approved. Yes No
Date: By:
No . VA No . .. .
,.
* A.GAEATHERINGTON&ASSOCIATES INC.
„TEMPQRARYir
;'sArr 428' REGISTERED LAND SURVEYORS
xEv, ,7/1/73 F. 0. Box 1417
Telephone 461-8084 5121 Briargate Lane'
FORT, PIERCE.'FLORIDA' 33450