HomeMy WebLinkAboutD O H - APPLICATION SEWAGE DISPOSAL FACILITIES1�
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v-v_County Health Department
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DIVISION OF HEALTH
Application and Permit
of
Individual Sewage Disposal Facilities
Section I - Instructions:
1. Percolatinn test data, soil pro-
file and water table elevation
information must be attached.
(Note: Test must be'made at
proposed location of system).
2. Existing building and proposed
A. buildings,on:lot...mu$t,be shown
and drawn to scale at their
location or Prouosed.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.
5. Indicate name and date of
recording of subdivision. If
not recorded, attach metes and
bounds description.
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 461-535o and give
'-,this office a 24-hour notice
when ready for inspection.
Section II - Information:
1. Property Address (Street & House No.) Jeffrey Lane
Lot 6 Block subdivision Cardinal Glenn
Date Recorded 4-TT-77 Directions to Job East on Weatherbee Road, North
on Areca Pam rive, East on Jeffrey Lane 200ft. lot on left
2. Owner or Builder Mathew McAiarnen
P.O. Address IO2 ores rive Port St. Lucie
3. Specifications
Tank Drainfield
Gals. ft. of 6" clay tile
or 5" perforated
plastic drain in a
3' trench or z
9� Gals. of 4" clay drain
or 4" perforated D
0
//plastic drain in an �.
trench co
4. House to be constructed: 'Y
nr.
Check one: FHA fD ('
m H-
VA X _ .Conventional
01
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This is to certify that the project m
rt
described in this application, and as m
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Scale 1" = 50'
(Rear)
THIS PERMIT EXPIRES ONE (1)
NEAR FROM DATE OF ISSUANCE
Permit VOID if well or septic
system is installed in a location
other than area permitted.
PRIOR HEALTH DEPARTMENT,
APPROVAL REQUIRED
detailed by the plans and specifica- fD
tions and attachments will be con- x DRAINFIELD TO BE INSTALLEDo WITHIN THE SPECIFIED'FILLED
structed in accordance with state
requirements. -AREA.
rermi # 6523919& . ' SS
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Applicant: Matliew McAlarrien •- (Front) BY
,Please Print (Name of Street or State Road)S+t Lucie County
Signature: Jt,,.q„Q Date: Mare. 901978
* * * *- * * * * * * * * * * DO NOT WRITE BELOW THIS LINE
Section III -
1
The above s gned`application ha's been found to be in compliance with Chapter 17-13,
Florida A inistrative "C�J''ode, and construction is hereby pproved, subject to th
above; s tions agpK.conditions.
By: /�y County P..ealth Dept. �t e Date ���/J�
Section IV - 'nal Construction Approval
Construction of installation approved: Yes No
Date: - By:
FHA -No. VA No.
TEMPORARY
SAN 428
REV. 7/],/73 -