HomeMy WebLinkAboutSURVEY - APPLICATION SEWAGE DISPOSAL FACILITIES�. STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
• DIVISION OF HEALTH
i Post Office Box 210, Jacksonville, Florida 32201
( APPLICATION AND PERMIT
OF
\ INDIVIDUAL SEWAGE DISPOSAL FACILITIES
Application / Permit [�
No. egad 5'".i•��/
Section I - Instructions:
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
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.
SAINT LUCIE County Health Department
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 available,
2. Individual well must be 75 feet from any part of
system.
3. Call and give this
office a 24-hour notice when ready for inspection.
Section 11 - Information:
1. Property Address (Street & House No.) Bartow Street -
LotE901 162 Block 11 Subdivision Una Indian IVer s a'i oo
Date Platted _.Directions to Job S on -US; 1 'O E� a9p- Fmk -on—Easy D uc al
N on'Buchanan to Bartow-E on Bartow to Prop. B on S S
2. Owner or Builder Eugene Herndon
P. O. Address City Fort Plercos Florida
Septic tank system to be installed by:
3. Specifications:
�1C0 .,gallon tank with
3e0 square feet of
drainfield with at least 4" Inside diameter pipe.
4. House to be constructed:
Check one: FHA VA
Conventional
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•This is to certify that the project described in this
application, and as detailed by the plans and speci-
fications and attachments will be constructed in ac- M
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cordalnce with state requirements. g
Appll✓;ant: Eugene Herndon
Scale 1" = 50'
(Rear)
THIS PERMIT EYPiRES OfdE (1)
YEAR FROM DATE OF ISSUANCE
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P'AselPrint (Front) -
(Name bf Street or State Road)
Signature:
L�v/ Date• .-'_z/-96
• DO NOT WRITE BELOW THIS LINE. SC�A,�INED
BY I
Section III - Application Approval & Construction Authorization St Lucie County
Installation subject to following special conditions: -
SlrI'i/c TO, Srr /Jr n5" y7RauE �eu✓� OF .fatly
The abcqe signed application has been found to be in compliance with Chapter 1OD-6, Florida Administrative Code,
and/6o tructioIt Is?here a� appr Ved, subject to the above specifications d conditions. r7 .
per _ J d.
gy, i o r.� County Health Dept. _ r�� Date �E
• • r • • • • • • ' • • • • • • • • . • . • • • . • • • • • • • •• •
Sectl IV •Final Construction Approval
Construction of Installation approved: Yes No
Date: By:
FHA No. VA No.
SAN 428
REV. 3/75
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LLGO L oe5CQlPTl0U
E05T 90 FEET 017-
,L.OT5 142 BLOCK H UNIT 2
I6D1no QIYtQ t-5 n-ra-5
POT&+ O •'3ThiL 1260O
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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 Y
ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF
AND THAT THERE ARE NO ENCROACHMENTS EXCEPT AS
SHOWN.
W. J. SCH NTDRIVE K
y`( _(�.f`+ _ 1671 THUMB POINT DRIVE
REGISTERE LAND SW4V YOR FORT PIERCE FLORIDA 33450
FLORIDA CERT NO 3169 2-Z1-1e
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