HomeMy WebLinkAboutAPPLICATION SEWAGE DISPOSAL FACILITIES'~ STATE OF FLORIDA r
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES !
DIVISION OF HEALTH
Port Office Box 210, Jacksonville, Florida 32201
APPLICATI N AND PERMIT
�OF
INDIVIDUAL SEWAGE DISPOSAL FACILITIES
Application / Permit
,i
No,"0
00 _% ST. 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 subdivislon. 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
be shown and drawn to scale at t4ir location or
proposed location; (Use block on this sheet or attach ,' NOTES:
plot plan). . • 1 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
System.
s'
Plan. •�.J .+.J D '
4. Any pond or stream areas must be Indicated on the 3. Call and glue th(s'
plan. office a 24-hour notice when ready for inspection.
Section II - Information:
i
1. Property Address (Street & House No.) Industrial Avenue 3, Fort Pierce, Florida
Lot 1 Block 6 Subdivision Airport Industrial Park "
Date Platted Prior 1972 Directions to Job Industrial 33rd Street to Industrial
Avenue 3 east on Industrial Avenue 3 to job on right
2. Owner or Builder R.K. Davis Construction Company
P. 0. Address 4205 Metzgar City Fort Pierce Florida 33450
Septic tank system to be installed by: "
i
3;-- Specifications:-
�h gallon tank with
4/f square feet of
d
drainfield with at least 4" inside diameter pipe.
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4. House tb be constructed:
Kn
Check one: FHA VA
a
Conventional
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v
o
This is to certify that the project described in this
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application, and as detailed by the plans and speci-
fications and attachments will be constructed in ac-
9
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cordance with state requirements.
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Applicant: R.K"r'}Davis Construction Co.
Scale 1" = 50'
MIS RERMIT EXPIRES ONE (11
ttMR'FROM DATE OF ISSUAKCE
SCANNED
'BY
St LF'APPROVAL
nt
VOID if waif or septic
is insfafted in a location i
han area permitted.HEALTH DEPARTMENR'C
REQUIRED
D22
Please, Print .(Front)
/ % (Name of Street or State Road)
Signature: (" Date: _April 7 0': 1 9'7 8
A�2LAlexan er H. Fraser, P.E. #16178 '
• a • • • • • • e `e' b •s.. �' • DO NOT WRITE -BELOW THIS. LINE'.* •'!;o:' b . • a' • _.e . •••.;a',`u '• ',a •'� �'.
Section III - Application Approval & Construction Authorization
installation subject to followin special conditions:
The above signed app tl s an found to be in compliance with Chapter 10D-6, Florida Admin rail Code,
and c n ruction is e r ' d, sub' ct to the above specification a conditions.
By:
County Health Dept.�j��//��� Data
1���C•v--�.v�v
SuctionConstruction APProvo`
Detructlon of Installation approved: Yes No j '•`
ate: By:
:HA No. VA No.
0 0 • • o o • e • • • • oY,• • • • a • • • • • • • • o • • • • 0 0 • • • ♦ • • '
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