HomeMy WebLinkAboutOWNER BUILDER - APP SEWAGE DISPOSAL FACILITIES (THROWBRIDGE)ia•
Application/Permit
• No.. '.JJ12) ?77
aU County Health Department
' DEPARTMENT OF HEALTH
AND REHABILITATIVE SERVICES
DIVISION OF HEALTH
Application and Permit
Individual Sewage Disposal Facili,'�ties
Section I - Instructions:
a '
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 and and give
,
tank must be shown on plan.
this office.a 24-hour notice
4. Any pond or stream areas must
when^ready for inspection.
be indicated on the plan.
Section II - Information:
`
1. `Property Address (Street.,& House No.)
Corner of Trowbridge Rd and Orange.
Ave., Ex
Lot Block Subdivision
See attached legal -
Date Recorded Directions
to Job Corner of Trowbridge Rd, and
Orange Ave, Ext .�
2. Owner or Builder Robert Hall
P.O. Address P.O. Box 1783City
,-,FOrt
Pierce. .Fla `
3. Specifications
Tank Drainfield
Scale 1", = 50' SCANNED.
Gals. ft.•of 6" clay tile
I BY
or 5" perforated
(Rear)
St LudeOUllty
'
plastic drain in a
3' trench or
z
THIS PERMIT EXPIRE-; 0'1.•17 (ij
;
_25(Gals. ft. of 4': clay drain.
YEAR FROM DATE OElS&tJAKE
z
01'ur
4" perforated
plastic drain in an • `
°
Permit VOID if well or s2Pti.-
rq
�, ,�� Ztrench
In
system is installed in a locitien
r
4. House t e constructed:
m
other, d..
than area permitte
Check one: FHA
m r•
PRIOR HEALTH DEPARTMENT
� m-
VA X Conventional
o m
APPROVAL REQUIRED'
o "
DRAINFIELD TO BE INSTALLED
This is to certify that the project
m
a
VJITHIId THE SPECIFIED FILLED'
m
described in this application, and as
ft
detailed by the plans and specifica-
m
AREA,.
m `
tions and attachments will be con-
structed in „accordance with state
requirements.
1 Z39&'9J
Applicant: Robert Hall
(Front),
' .•Please Print
(Name of Street or State Road)
,
Signature:
Date: Febuary 21, 108
:; * * *' * * * * *�* * -* * • .* * DO NOT WRITE
Section.I1I - Application pproval & Construction
BELOW THIS LINE
Authorization
Installa ion subject to follow' ng speaia}/
�� .�'N�/i/i_...0�.1111u.�YI.l3_m—,it..,�-�..•n�lJ_�j`"�o—"��+'c�
con ditions: • /
Florida Adpinistrative Code, and construction is hereby approved, subject to the
above s ® ications a7 conditions.. '
By: (/ County Health Dept. `- Dat
Section IV - final Construction Approval .
Construction of installation approved: Yes No '
Date:,' By:
FHA No. - VA No: ,
TEMPORARY
,SAN 428
REV. 7/1/71,
1J
a �0
NOTICE: OWNER/BUILDERS
OWNER/BUILDERS OF ONE OR TWO-FAMILY UNIT DWELLINGS, OR COMMER-
CIAL BUILDINGS UNDER $25,000.00 IN VALUE, ARE EXEMPT FROM THE
REGULATIONS AS SET FORTH IN FLORIDA STATUTES 468 WHEN BUILDING
FOR THEIR OWN USE AND OCCUPANCY ONLY.
THE SALE OR LEASE, OR OFFERING FOR SALE OR LEASE, OF SAID
STRUCTURE IS A CRIMINAL VIOLATION PUNISHABLE AS A MISDEMEANOR
OF THE SECOND DEGREE.
'IN ADDITION,_ IF THE OWNER/BUILDER DOES SELL OR LEASE THE DWELL- SCANNED
ING, HE MAY SUBJECT HIMSELF TO A CIVIL LAW SUIT. BY
St Lucie County
I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE
NOTICE ON THE DAY OF 1978.
9w, �, I -
OWNE /B ILD•R
2,S9D8