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NOTICE: OWNER/BUILDERS St <<iciB county
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-
ING, HE MAY SUBJECT HIMSELF TO A CIVIL LAW SUIT'.
I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE
NOTICE ON THE DAY OF �%% �j(if� , 1978.
'�eYm
OWNER/BUILDER
BTATL OF'TLORIDA'�
• r , DNT EPARTMEOt, HEALTH AND RLRARILITATIVEBEDVIL7D•'IL.
• e.: '�"" •._� D"ION OF WEALTH .� ^•r'r ; t, n^t� r
. l \ q ii \yeih ,
ApPhicati�and Permit
Individual Sewage Disposal Facilities
APP, iQ�°Pe t ,
Nd.l 7 -� �T. �G�C/E County Health Department
t
Section I - I-nstructions:
. Percolation test daFa, soil pro- 5. Indicate name and date of p'lat
..file and water table elevation of subdivision. If not plaited,.-
information must be attached. attach metes and bounds description..-
(Note-' Test must be made at 6. Complete the following infor-.." "^
proposed location of system). mation section. y;,t
2. Existing building and proposed
buildings.on,lot must be shown Notes:
and drawn to scale at their i. Not valid if sewer 'is available.,,
location or proposed location. 2. Individual well must be 75 feet -
(Use block on.this sheet or from'any part of system.
attach plot plan) . 3. Call and give-
3. Proposed location.of".septic tank this office a 24-hour notice
must be shown•on plan. when ready,for inspection...,
4. my pond or stream areas must be
indicated on the plan.
r
Section II Information: / Trrt
. Property Address ,`(Street & House No.) SUNSET ' z e),P
Lot / 3 Block Subdivision S v .0 ivE.t<'
Date Platted,. /r�Directions to Job o o.o
5' , o.V Stltis• ez "r -
2. Owner. 7 or Builder
P.O. Address T 3VX City iEPc
Septic; tank system to-"e,instal ed by:
Ce�D/�E Scale 1" 50', SrLu'""
Y ;
ieounfy
f (Rear) ✓':, c a ,
r .fir- , 45. � •.,.. ne 1. Lri„ 1 `•' ' { , '1'
3' aSpe if'icat'ons.
gallon tank kith
,.
S square feet of
w
drainfield. with' at least
g.
4",inside diameter..pipe.
4. House '-to .be constructed:: .
0
Check:*one: ,'FHA '
w
ITA Conventional
w-
This, is' to' certify.,that the
'*
project describ'ed'in.this
„..v
application, and as detailed
by the plans _and specifica-
M
tions and attachments will -be
fi
constructed in accordance with
o_
state requirements.
0
Applicant:�i�E�
Please Print
'
(Name -of Street pr State Road)
Signature:
Date: 3�Z/ 7R
DO NOT WRITE BELOW THIS LINE
Section III
- A location Approval & Construction Authorizat' n ;
I Installatio4
s ject.to fq lov�sng'specia conditio�} s:
l� �0 � r/3 - ��__,n,. C YC� '
`�Thea ov
signed application has-been, found to a in compliance'.
with Chapter
1OD-6; Florida Administrative Code, and construction,
is Her
a proved, s j`ect to the above specifi tions and cond'tio s
By:.
- County Health Dept.J Date
47.4 6Section
IV -
nal Construction Approval
Construction of installation approved: Yes No
Date:
Bys
gNa.`Nn.
VA No.
' ,*r*:�*••*f•irt.f*,t��f,:••,e•
*•tr,►.,ttt*,**s��s**•,►e**�,e,e* • **#,+rwfr�ttt*,�*a * *,t w
SAN 428
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w•
ST.11A:' F_ j7ounty Health -Deoartm'ent
! DEPARIMENT OF HEALTH AND REHABILITATIVE SERVICES
DIVISION OF HEALTH
Application and Permit
of
Individual Sewage Disposal Facilities_ :......
DATA SHEET
Location:-4/ oT /3.LA-- 7� 4417-9 Applicant:-
�it>D �/y. E9 Til�TEs' County:-5 T7
NOTE: This septic fork system is not located within 50feet of the high water line of a take, stream, canal or
other waters, nor within 75feat of any•private.welli nor within 100feet :of any publie.water supply;
nor within 10 feet of water supply pipes', nor within 100 feet of any public sewer system.
c-VtiT
J
. Cv
1
Plot plan must show
all data required in
and
'all •oth'or. 0.' Ltjntn''r'.•,
data.
/ wlc /X) T S�eyNE�
squcie C
PLAN County
SOIL ,
SOIL DATA LEGEND
0 17 JgeowA) Drainage Pattern
P S
I 5 � sgNO _Proposed Septic Tonk and
-- Drainfield
in 2 ®Proposed Water Supply Well
3 0Existing Water Supply Well
o' 4
®Soil Boring and Percolation
•p51. i
Test Location•
0 6
0 7
i
0
SOIL BORING
LOG
Soil Identification: CLASS 1 GROUP
Soil Characteristics SEE L
Percolation Rote NA min/inchlx 5e>�°p7/�N
/. \ .4 p7 B��pGtJ iPD /io
R'oter Table Dapth /✓� CERTIFIED BY:
Water Table Depth
During Wet Seoson FLORIDA PROFESSIONAL No. Z�✓z�7
Compacted Fill Of Regd. polo ✓ Z� %8 Job No.
Compacted Fill Checked By:
Dote Shoot of
ST
1976 IiAR 28 Ni9 it: S3
ZONING & BUJLD�.t,,%
DCPARTMEf1T