HomeMy WebLinkAboutAPP SEWAGE DISPOSAL - SEWAGE DATAJ.pplca on7(Permat :L`. -
No. ' Si' . LUC 1 E County Heal
th''L Zrtment
., DEPARTMENT OF HEALTH AND``{2EHABILITATIVE SERVICES
'DIVISION OF HEALTH
•
Application and Permit
of
Individual Sewage Disposal Facilities
,.
..,Section I - Instructions:
1. Percolation test data, soil pro-
5. Indicate name and date of
'
file and water table elevation
recording of subdivision. If
information must be attached.
not recorded, attach metes and
(Note: Test must be made at
bounds description. •
proposed location of system).
6. Complete the following infor-
2. 'Existing building and proposed
mation section.
.-_,buildings on lot must be shown
'and drawn to scale at•their
Notes:
location or proposed location.
1. Not valid if sewer is available.
- -
-----,-(Use block on this sheet or
2. Individual well must be 75 feet
attach plot plan)_.
from any part of 'system.'
€-
3.Proposed location of septic
3. Call 461-5350 and give
tank must be shown on plan.
this office a 24-hour notice
Any pond or stream areas must
when ready for inspection.
.',be indicated on the plan.
` -
Section II - Information:
.'�1. Property Address (Street & House No:J
_
Lot J Block C Subdivision-y!17r�
Date Recorded Directions to Job / /,o,c/ 70 ,- •'sA!�-7cCf7,lJ�7C
�� fJ.4�f-%rFIIJ E^,%'C�'i,t%'�/ ,C'�f7 � '�, f-/��-7/`''/OG�f � �i.%� I,✓•O'.✓�:/
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2 Owner or Builder 1z3i , L-
r(_/
P:O. AddressCity
Specifications G J?A,1c
r .
Tank Drainfield
Scale 1" = 50'
(Gals. ft. of 6" clay tile
i. or 5" perfoiated
(Rear)
plastic drain in a
% Lf 3' trench or
z
z
!� Gals.�G - of 4" clay drain"
SEE ATTACHED
n'
'
or 4 perforated
/i plastic drain in an
M
a
M
d`/ trench ..
A,;
4. House to be constructed:
rt
.N
• "Cheek one: FHA
m m
N
,<' r;1„ �,�,�..` .;�/
' ,""'l •«.f '
m
M 0
�t
Sj
VA 6^'` Conventional
rr n,
1✓. '" -'
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.t_ SCANNE
This is to certify that the project
En
BY
rW+
described in this application, and as
w
�
St LU I@ CiOU
tym
�.
detailed by the plans and specifica-
lions and attachments will be con-
structed in accordance with state
requirements.
�2
rZ_)ef' %-N � 0-39 j Lf
Applicant:
(Front)
(�
Print
(Name of Street or State Road)
,^
IPlease
Signature:s!_iYiJ,:
_. 1
;-9�::i
Date:
''� NOT WRITE
BELOW THIS LINE
-'
'.Section III - Application Approval & Construction Authorization
special conditions:
Installa�dri-svbje.t to f�a
-ng
'
The above signed application haY been
found to be in compliance with Chapter 17-13,
Florida r istrative� Code, and construction
above s €ic t ggnns�ag� onditions.
is hereb,Y approved, subject to th
�- �+ a�
By: Y �/J /�� County
Health Dept.f Date�7�"
section IV - Final Construction Approval
Construction of `installation approved:
Yes No
Date: By:
- ---
FHA No. VA No.
-_
# # + * # # # # # * # * + + * # * + # #
A. 0. WEATHERINGTON & ASSOCIATES,
INC.
TEE,I MP ORARY
.
SAN 428
REGISTERED [AND SURVEYORS
lxEv ;� 7/1/73
P. 0. 86X•1417
' +
Telephone 461.8084 - 572I Margate Lane
FORT PIERCE,`FLORIDA 33450
r 7�X �h`y /MD/KLOI/AL' SEiY'.96£ DISPOSALF FACX1r1lrS
� 55 ° DATA Si/££t � tit d. t f . - •� .,. " 1 , !! w .
s^.4�''k�''`'4,�4•'#M.. t r r:'� `,� '+r a, ✓K�- " r'tt
AbAtipn QT-� / Qr„K �-y plicQnt /IGG GE.t/'
'ST. LUCIE
4
+ NOTE; I TMf� �eplie tank eyetah.ie not located within. SOro Hof the high water lino"'of a. IoM, atreanl, cans' or
�+ ton, nor within 75fast of any privets well; nor within 100 Het of ony'pupdp water' eJpply;
w,fhbl 10'fNt ofh Ater,supply"ll ve•i nor within 100 }!df of ,any public wer ayaleT..
]a. • -I
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�gfilI ' ' - LOT ;:, I .Plot plan,riwar show,11
'
C,s , .:'? , .:all data -equire.•1
��
IOD.6.63. 2(a)`a�d
` �° d t�.xl �,�' ���) ��, • f` 011 at he"r, 1`�1:11 eht
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�i3 It °�v°���5"dtl 1 �� 1 , ,✓l_, /� i nR`. �1 r
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Tx x�° 27'
A ' Iy t j3 '' 1 set w i t T1 :Drainage'. Pattern' p , ^ •.ft 1� , 1 - ;} a ' .0 1 l f t 1 +ltr_
t i«Proposed' Sep}iC .O�Y and
` I _ ,
I' �,�Propoged Wgta Supply Well
N " /�,1�cr!>"/r�ia S?Nt� I Well -
!QEuaflnq water SupG Y
yfn A.,"�. `IF 1I.
- �f$0111�0! in,q .9-A P•colr°'oe' r;
`•Teat ' Location
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,r$oli'IdeattficoIIon CLASS ORauP. _ t
Sell ChoroaterUfice, - .� ���
C�.4YC�
gt ,ParR0igi 01 41.
nlilt•rer tojft•lR d�oth:_ + ,;' CEIttIFIED ?9Y'`}
`" iYotpi Tablet bip,h „ : t859
FLORMA PROFESSgN11L .1. Iq
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�Compoat•d'fill
M > "R•qd Dat• Job 'No.
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`I..GERAL-0 �WEAAT
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`'JtE6lStENED t D`SURVEYOk:
V.P' 0' Box i17
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,� , xra'D� .`, �, � ,' �I, �Foot�l�erce,'Floride 33450 �•-;
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