HomeMy WebLinkAboutD O H SEWAGE DISPOSAL FACILITIESSection I, 'Inst
1. Percol"ation
file and wat
information
(Note Test
proposed ;low
2.'' Existing�ibu9:
buil',d ngs`bn
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and drawn to
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(Use' block ,o
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Count} Health Department'
DEPARTMENT OF HEALTHAND REHABILITATIVE SERVICES'
.
DIVISION OF HEALTH
Application and
Permit
OE
Individual,Sewage Disposal Facilities
1 / + ,•
ions
1
t;adata; soil praT+r `, 5
Indicate name and date of
y:
able elevation
recording;',of subdivision. If
xQ
kie attachad
not recorded, attach metes and
',Lrr ma5e'�at ^` 1
bounds description.
r :;rf' , tett+1 . 6.
Compiete. the Ifolldwing infor= '
g,and p.6posed �" :< .j,.
mation section. ,
"°.9'.uBt, ..be,shown
ae atvtheir Notes
f=
oseddlecation i'i , " 1>
Not valid if sewer is available.
is, sheet7..
'Individyal well must be 75 feet
.'or
r s
�frtiu4• ang part .of system:
+
n:'of Septic %'' r 3
Ca71 " L61 53K0 and give
tank must �e shown on plan this `Office',a 24-hour notice k .
Any pond or stream areas must };^ :.when..ready for inspection.
be indicated on';the plan.
ii 'Information r r SCANNED �".
� ----
rty =Address'::(Street & House•';No.),'Hidden Pines^J BY
3'. Block. C' Subdivision Hi den Pine; LUria:'COUlltyrG,'
RedOlce "5-'f2 T,Directidns to .Job West.'on. Okeechobee•. North on
Midge, es on idderi"P'nes'�ffo�d 300ftL'ot on>le£t a �' `•
c or';-Bli1'der eeiLeamin
Aadress1°1,8 Pa mebtb I4Hm�+ ,. ort Pierce s
t-io s
peci ica n
Tank '
Draanfieha
Scale 1" -`'50'
_G l's.
ft. 6':clay file
or 5" perforated
{.Rear),',
}
plastic drain in a`"`..'
. '� .. 3;:trench Or
z
�
1
cc
�J 'Gals,. -
t:� of 4'� al ay drain
w.°
VISPERMIT EXPIRFSOKEQff�'
or 411 perforated ,`F
°'`'
FROM DATE'OF•OSSUAN E
%plastic` drain in an`
Sk
Mj5
,YEAR
r
ro
kv s
- trench"
'
i VOID +T vweil dt sepiic
rt' 'zF
4.' House , to b
constructed
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4
Check
F iA
r �, }Y5t^rf r8 irstailed+n�a {ecation
m„ �•�,
one:
VA
�conventional,
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# e ter ih.n a Ga pC iRttsd.
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i�itF.I + h 4 1?TVvIE �I
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�€�S}IRCD
This his t certify that the rpro7ect " z'
`
descri)?enthis apph`cati"I and as, l
�,•
pRAINFIELb{fp U {'ivS(RLLE '
detailed bYfthe plansl'and specifica
1M/17HIN'TFl�SPrglEDpBte[n
" bons..and l attachments;`>wa ll Jae con
,
a�
AiiEA 1
stxuctdd 'in a cordano. with
estate
requirements ' s t >
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pd .
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Applic
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Sect:
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TEMPI
REV
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on IV E a1 Consti c'a6n
:onstruction o£ installaitio:
)ate .:'ire
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F f± !
(Name., O£ Street Cr tate Road) +
IS .-
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aalth
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Yps R +'
No rs
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.41
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