HomeMy WebLinkAboutSURVEY - APPLICATION SEWAGE DISPOSAL FACILITIESi
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DIVISION OF HEALTH
Post Office Box 210, Jacksonville, Florida 32201
h APPLICATION AND PERMIT
OF
INDIVIDUAL SEWAGE DISPOSAL FACILITIES
e
(cation / Permit
c
No. C 140 tl -,J 8 SAINT LUCIE County Health Department
1i ,
Section'; I - Instructions:
II
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
r
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:
II
0
I
II.
II
II
r,
1
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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 avoil'able. '
2. Individual well must be 75 feet from any part of
system. L
S
3. Call /C' 5�0 and give this "
office a 24-(tour notice when ready for inspection, ,
1. Property Address T j,fHy&e2No.) JB8rtOW Street
�Pt1,190t❑f' F gloe Subdivision Indian
Date Platted —Directions to Job -Son US •1
N 061Runhanan tri Rartoiu-F on Bartow1951 to Prop,
River Estates
to Easy St-E
on S S
Unit 2
on Easy to BUCK n�[t
tl!
2. Owner or Builder-Fugana Harndon
RY
P. 0. Address City Fort Pierces Fl
St LueneGOUI$y,
,
Septic tank system to be installed by:
Scale 1" = 50'
•
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(Rear)
G��,
1✓ '
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3. SDecifications:
%CU gallon tank with
THIS P.ERM)T EXPIRES
quare feet f 2
OME (1)
YEAR I$iUh7 p,1,TC'OF
a
drainfie d with at least 4" inside diameter pipe.
ISSUANr•':
4. House -to be constructed: I W-y
i1-C;fitil I OP3 if wool
Check one: FHA VA
m a
'
or gnptlC
s1'S1Cnt Is frr;l. 11, 1 it, location
u e
ry
Conventional ^ '°
o —
Olhnr' ih a't nr`.1 ♦ orrniti C!1.
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,This is'to certify that the project described in this
^f 'vi )i�l,:i,r,f; i•I
v
f'ry
application, and as detailed by the plans and speci- ,s
-
1p
ficatlohs and attachments will be constructed in ac- o
o
cordance with state requirements. g
D2Ali:1'filCl TO Pl- INSTAIA.lilt
o.
Applicant: Ftrgana Hgrndnn
PI se, Print
(Fro* -.
>
(Name of Street or State Road)
Signature: 4 Date:
• • '�• ' • • • • • ! • • DO NOT WRITE BELOW THIS LINE • «
•
Sectio�III - Application Approval & Construction Authorization
Installation subject to following special. conditions:
SFPj/C 74,V K YOB - /SF Sr - .2S�'
196041E Cf0e,2,0 Of a00,217
"
The abov signed appllcatiol has been found to be in compliance
with Chapter 10D-6, Florida Administrative Coda,
and?consruction is Preb� pprad, subject to the above specifications and conditions.
,
%>i�!1-ft�County
Byy Health Dept.
u:G'-L�-� Date +1s 61
ectionnal Construction Approval
Construction of installation approved: Yes,
No
Date;
FHA No.' VA No.-
I,
. •I• . . • • • • • . • • . . . . . . • . • • . . . • . . • • • . . . •
.
SAN 42a
REV. 3/75
I.
I -
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'worr: O• Srnrl. 400e
h
BY
n/ St Lucie C
S- bnQ ITO>g 5-r
UGn1. Dt5CQIATl0W
W EST 90 FL -'ET Of T 14f�-7 LAST IBO FEL-.T
LOT5 I � 2 BLOCK II L)OIT2
1"oloki QIVElQ E5TATI Z5
I HEREBY CERTIFY THAT THE PLAT SHOWN HEREON IS A
TRUE AND CORRECT REPRESENTATION OFA SURVEY MADE
UNDER MY DIRECTION AND THAT SAID SURVEY IS
ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF
AND THAT THERE ARE NO ENCROACHMENTS EXCEPT AS
SHOWN.
,I
REGISTER(EP LAND V EYOR.
FLORIOA CERT NO 3169
�rO 4 P
W. J. SC'HOEPFER
1671 THUMB POINT DRIVE
FORT PIERCE FLORIDA 33450
2.27- 78
m i FILE