HomeMy WebLinkAboutOWNER BUILDER - APPLICATION SEWAGE DISPOSAL FACILITIES0
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-
ING, HE MAY SUBJECT HIMSELF TO A CIVIL LAW SUIT'.
I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE
NOTICE ON THE 1-7 DAY OF �2/L , 1978. SCANNED
BY
St Lucie County
ER/ UILDER
'PL-Y M,14,
2 LI O LSD
F � r
Applic i'on / Permit
No. 6408 0?i�s-
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DIVISION OF HEALTH
Post Office Box 210, Jacksonville, Florida 32201
APPLICATION AND PERMIT
OF
INDIVIDUAL SEWAGE DISPOSAL FACILITIES
SAINT 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 subdivision. 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. E�isting 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 NOTES:
+o plot plan).1. Not valid if sewer is available.
i " 3. ' Proposed location of septic tank must be 'shown on 2. Individual w II t be 75 feet from any part of
plan. system.
4. Any pond or stream areas must be indicated on the 3. Call and give this
plan. office a 4-hour notice when ready for inspection.
Section I I - Information:
J 1. Pioperty Address (Street & House No.) Bermuda Drive
Lot 14 Block 4 Subdivision Sectibon 1 Coral Cove
Date Platted 195E Directions to Job E on North Br dge Royal Palm Dr. to
Coral Avest: n Canal to Bermuda Dr.—U on Bermuda to Pro a 10781 on N/S
2. Owner or Builder r1rs, Dick Jackson
P. 0. Address City .Fort P ercell F •
Septic tank system to be installed by:'
Scale 1" = 50'
( Rear)
XHIS
3. Specifications: gallon tank with 'flF9RfJ?Oryjt pATE��ES ONE (1)
square feet of d F ISSUANCE
drainfiel with at least 4" inside diameter pipe. m m
o 1
4. House -to be constructed: y
Check one: FHA VA a �ermitVOlO a»
Conventional o othere� is insf �I�ett or septic »
This is to certify that the project described in this d PRIOR than area C Cn
In -1
lon
application, and as detailed by the plans and speci- AI'PRO Tf/ pfP t,.�
fications and attachments will be constructed in ac- o VaC RFQIIAIREpr£NT'
cordance with state requirements, a
Applicant: Irlro Dick Jackson 24,DLOD Y
(Front)
Please Print i btLuucle County
(Name of Street or State Road)
Signature: Date: February 15s 1978
• /NOT WRITE BELOW THIS LINE • • % • • • • • N
Section III - Application Approval & Construction Authorization
1'subject to
/C 7—AA
The nae itnedapplicati h enfo ndtobe in compliance with ha er 1OD-6, Florida Admini trative ode,
and coon is hereb r ed, s' act to he abov-e, specific 1 conditions.
By; ty Health Dept. Date as
p N Y N N Y• N N N• Y N N%%% N N N N% N% Y N N% p Y% p p N• Y
Section IV Final Construction Approval
C struction of installation approved: Yes No
Da e: By:
FHA No. VA No.
* r ♦ p • • w r w N ♦ r • • • w w • r • w • N • • • p • w • • • • • • w w
SAN 428'
REV. 3/75
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