HomeMy WebLinkAboutSURVEY -APPLICATION SEWAGE DISPOSAL FACILITIES25
aP)TZ %O W
LtCnL DL5CQIP7-10Q
wr-s-r Ito FEET ol`-
4,OTS It2 $iOCK II UIJI7 2
Iur->lp J utyr-Q E9TL1TCg
I HEREBY CERTIFY THAT THE PLAT SHOWN HEREON IS A
TRUE AND CORRECT REPRESENTATION OF ASURVEY MADE
UNDER MY DIRECTION AND THAT SAID SURVEY IS
ACCURATE TO THE BEST OF MY KNOWLEDGE AND:$ELIEF
AND THAT THERE ARE NO ENCROACHMENTS EXCEPT AS
SHOWN.
REGISTERED D SURV JR
FLORIDA CERT NO 3169
plio
1 5c
n
SCANNED
BY
St Lucie County
Tam; � q�
17
ao -9
W. J. SCHOEPFER
1671 THUMB POINT DRIVE
FORT FIERCE FLORIDA 33450
2•ES-18
m
I FILE
I
v STATE OF FLORIDA
+ - DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DIVISION OF HEALTH
Post Office Box 210, Jacksonville, Florida 32201
APPLICATION AND PERMIT
OF
INDIVIDUAL SEWAGE DISPOSAL FACILITIES r
Application / Permit No. f9 •—a 8 7
SAINT LUCIE County Health Department
Section I - Instructions:
1. Percolation test data, soil profile and water table ele-
5. Indicate name and date of plat of subdivision. If not
vation information must be attached. (Note: Test
platted, attach metes and bounds description.
must be made at proposed location of system).
6. Complete the following information section.
2. Existing building and proposed buildings on lot must
i
r
be shown and drawn to scale at their location or
proposed location. (Use block on this sheet or attach
NOTES: i
plot plan). •
1. Not valid if sewer is available.
!
3. Proposed location of septic tank must be shown on
2. Individual well must be 75 feet from any part of
plan.
system./���SC�
4. Any pond or stream areas must be indicated on. the
3. Call ]- and give this
'i
plan.
office a 24-hour notice when ready for inspection.
Section II - Information:
1, Property Address (Street & House No.) S$E corner of Bartow and Buchanan
Lot W 1201 1&$lock 11 Subdivision
Unit 2 Indian River Estates —
Date Platted Directions to Job S
on US 1 to Easy S —E on Easy to ue anan—
N on Buchanan tp Prop. on S
E corner of Buchanan & 8ar ow
2. Owner or Builder—EUQene Herndon
P. 0. Address city Fort Pierce, Florida.
Septic tank system to be installed by:
Seale 1" = 50' SCANNED
It
(Rear) 1 BY
(, }St Ludie
(fi{i5 C F,t(ie1''1' 1'N,i''IRi7; f)Jl' i.
Coun ';
3, Specif'cations:
�I QAI Ci i;;' V •4r;..""I ; i
,gallon tank with
-�^ `
3 &-n square feet of
2_
_ _ -, _ " _ _,..
d
drainfield with at least 4" inside diameter pipe.
3
'
o
'I'^nni'11C:i`1 i�`': li „r •.il iiS:
4. House to be constructed:
y'-.
n� r", iir:l..ilarl in.l iccation
0
cn
ii
Check one: FHA VA
„ ui
c :1"l ;It In +tr^n i'^ntiltl^ti.
-
w B
1
Conventional
I UEWV2TrdLNT
o
Q
ItI'i'i:U IA!. I;CC?t:IRFJi
o
J
This Is to certify that the project described in this
m
TO IPJSI'P,I.LED
d
application, and as detailed by the plans and speci-
�
D1i1\{IJJIGtD
T1l(: �j-i�CIF(CL) 4"IJ;LES?
o
ficatiops end attachments will be constructed in ac-
1'u1,11�i,i
cordance
with state requirements.
a
/''F'FJ�"
n,
a
"
Applicant:_
-Eugene Herndon
Plea e,Print
(Front)\ _
/
(Name of Street or State Road)
,!
Signature:
Date:
•• - /
ju
�I
• • • • • • • + DO NOT WRITE'
BELOW THIS LINE • •
. Section III' - Application Approval & Construction Authorization
i
Installation -subject to following special conditions:
75- Tinn rD f3 l3 T-
2 "' 4/3o",a e.'eaeaA) of O, /2
I
The a6dyye signed applicatio /as beg be in compliance with Chapter 1OD-6, Florida Administrative Code,
and ans4ruction is I eJeby a prov subject to the above specifications and conditions.
�i'.•
By: .^+ . - County Health
Dept. Date ti
• . . • . .. • • . • . . . . `. .
. . . . . . . . + • . . . . • • • .
il:
Section IV Final Construction Approval
.
Construction of installation approved: Yes
No
Date: By:
FHA No.
VA No.
SAN 428
i
REV, 3/75
I