HomeMy WebLinkAboutD O H APPLICATION - PERMIT - SEWAGE DISPOSAL FACILITIESk
T-
Applicat i6n/Permit
County Health Departmdrit
DEPARTMENT OF HEALTH
AND REHABILITATIVE SERVICES
DIVISION
OF HEALTH
Application
and'Permit
of
individual Sewage
Disposal,Facilities
Section Instructions:
1'.,,Perc?1ation test data, soil. pro-
5. Indicate name and date of
1. "file and water table elevation
recording of subdivision. If
information must be attached.
not recorded,,attach metes ap.d,
(Note: Test must be made at
bounds description.
proposed location of system).
6. Complete the following infor-
2`. E isting building and proposed
mation-section'.
buil5ings on lot must be shown
and drawn to scale at their
Notes:
location or proposed location.
1. Not valid'<if sewer is availabiie:
(use block on this sheet or
2. Individual well.,must be 75 feet,
d attach plot plan).
from any par of tsystom.
3 Prop?sed location of septic,
3. Call_LL61_�530 and, give-
tank,must be shown on plan.
this office -a 24-hdur notice
4!�' An v pond or stream areas must
wh Ay for"inspection.'
en,J rea
be indicated on the; plan.
86_ction'iI,,.7 InformA
,.tion:
1. Property Addre'W,41�,`Street & House'No.)
Lo t K 131611'ki� Subdivision
Lakewood Earl,[
o
Date Recorded'v!" Directions
to Job West on Indrio RoAd• "liorth on,,
i.
akewwod ParO,R!'65ad4'Bast on Santa
Barbara Dr. South on Gre'eh Dolphin
12�l
2. Owner or Build�Y`r'�": M.D. Donohoe
Lot on Right
P. oltay Ft. Pierce, Fla.
3! Specifications ',
Tank :Drainfield
Scale I"
Gals., fV.—of 6" clay tile'
"5" erforated
p
(Rear)
'ffl4stic drain in a
3,";e'hch or
, tr I
THIS PERMIT EXPIRES ONE (1) I
z
I
pry u� Gals. 300a/ .-;,"of 4" clay drain
YEAR FROM DATE OF ISSUANCE
ou
S
perforated
q�as drain in an 0
'L 1 ench
4 Houso to be, c,?n r ted. It
check one: FHA (D 0) H- (D
VA "Convent iona 1 M
0
0
rh
En
U) (D
P. (D
(D
0
Tfi;is is
o certify tha't' the project rt
W
described
in this application, and as
W
I_ddt�Liled
(D
Sy Ithe,'plap"�,,,4,and specifics- SCANNED
(D
tions' an
C �attachffient�',wii be con- BY
I I
JE
.
strddtedl
I
witi�state-
in accordance hl �StL Ucie Couity
require
S .
nts .....
Applican
K.D. Donohoe (Front)
1pfease,P * t of Street, or State,,Road) �n
Signature
k V Date : Oct25, 1977
DO NPT1,WR1TE,-1BELOW THIS.IINE
Sec�b16n.
III _:�Appli'64 t, tion Approval '& Construction Authorization"`
Insthllation
subje6t to following S, ia onditibnp:
T� 1
0.-
signed, c tionj hE s', be -' f und The�,` v to,,be,ih.compliance with,'Chapter 1713,'
p
S is ii6reby approved, sub' o.t to e;
Flord; a'Admin at ve d and construction e
abo,—. s -- Fie o s n dim rr
By. Count�y'! Health -Dept'%&
Secti 'I Final •Construction Approval
C ns ruction' of installation approved: Yes: No
at
1:
H No. VA No.
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TEMPOkARY
SAN 428
73 12