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+ ^' STATE OFt FLORIDA U ( '✓"T "�
6t':BAk1 MENT OF HEALTH AND.FiEHABILITATIVE SERVICES p
DIVISION OF HEALTH A
Post Office Box 210, Jacksonville, Florida 32201
'-7l APPLICATION AND PERMIT
OF
INDIVIDUAL SEWAGE DISPOSAL FACILITIES
Applicatio^�� /4/7
N o.
Section I - Instructions:
1. Percolation test data, soil profile and water table ele-
vation information must be attached. (Note: Test
must be made at proposed location of system).
2. Existing 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
plot plan).
3. Proposed location of septic tank must be, shown on
plan.
4. Any pond or stream areas must be indicated on the
plan.
Section II - Information:
1
SAINT LUCIE County Health Department
5. Indicate name and date of plat of subdivision. If not
platted, attach metes and bounds description.
6. Complete the following information section.
Property A Street & House No.) Dian
Lot fi Block Subdivision Ni
Date Platted Directions to Job S DD
2• Owner or Builder i4J f DOns'cruw;l
P. O. Address City Per
Septic tank system to be installed by:
3. Specifications:
gallon tank with
�3 t7(3 square feet of
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drainfield with at least 4" inside diameter pipe.
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4. House -to be constructed:
P ^
Check on VA
2?
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tionFHA
Conyenal
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This is to certify that the described in this
project
application,:and as detailed by the plans and speci-
fications and attachments will be constructed in ac-
0
cordance with state requirements.
a
Applicant: AJT Construction
NOTES:
1. Not valid if sewer is available.
2. Individual well must be 75 feet from any part of
system.
3. Call and give -this
office a 24-hour notice when ready for inspection.
s
Scale 1" = 50'
( Rear)
tT-HIS PERMIT EXPIRE- • - •
M13,FROM DATE OF. ISSUI.NCE
Permit VOID if well or septic
system is instilled in a loca`Icn
other than area perml'l:.".
PRIOR HEALTH DEPARTPrI--i ;T
APPROVAL REQUIRED -
DRAINFIELD TO BE INSTALLED
WITHIN THE SPECIFIED FILLED
AREA-.
`%rm;4, -9'Z39 29
Please Print (Front)
(Name of Street or State Road)
Si nature: Date•
w • • • / • • ♦ {! : x x x • DO NOT WRITE BELOW THIS LINE " • " x x • f • " "
Section III - Application Approval & Construction Authorization
Installation subject to following special conditions:
LD
M ED
BY
ie Coun'
The above/ ig ad application has been found to be in compliance with Chapter 1OD-6, Florida Admil istrative ode,
and co,nst//l(11 1 n is hereby appro`ye ssbbject to the above specifi ati s a conditions.
By: �GJ `/{ �� County Health Dept. 64c420 Date �/ ��
!• w f f R Y!♦ x f•• R•• R x•••• f•♦! f • f• f • f f Y! f f f
SCl/
IV - Final Construction Approval
Construction of installation approved:
Date:
U7
Yes No
FHA No. VA No.
f • • • • ♦ • • • • • ! • ♦ R • x • ♦ ♦ • f f • • w • • • w ♦ • ♦ f f • • ! R
SPN 428
REV. 3/75
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I HEREBY CERTIFY THAT THE PLAT SHOWN HEREON IS A per'
TiRUE AND CORRECT REPRESENTATION OF ASURVEY MADE
UNDER MY DIRECTION AND THAT SAID SURVEY IS -
ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF �I
AND THAT THERE ARE NO ENCROACHMENTS EXCEPT AS
SHOWN
SCANNED
BY
St Lucie County
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23gl.4
J. -SCHOETFER
J� 1671 THUMB POINT DRIVE
REGISTEK✓`U LAN EYOR FORT PIERCE FLORIDA 33450
2, /O-!e
FLORIDA CERT NO 3169
FILE S- pB
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SCAAED
Lt o c DESC t?/ oT�or/ St Lucie County
P9�EL 6�9
i1i,IrQS Eacr�
7f/t Y/eS% 747T Of LOT 7'AND7He- EFls7 26 fr
Of LOT B O/- F,jLK P OF Q/YCQ s &OG,- -7/p
F95 //! P.10r,8� // OF/Ga 2/ of- 7He"
/�VBL /C Q�CI�QlOS ST. G UC/E CCYJ/YrY,
I HEREBY CERTIFY THAT THE PLAT SHOWN HEREON IS A •%
TRUE AND CORRECT REPRESENTATION OF A SURVEY MADE e
UNDER MY DIRECTION AND THAT SAID SURVEY IS IP
ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF Ay /
AND THAT THERE ARE NO ENCROACHMENTS EXCEPT AS
SHOWN.
W. J. SCHOEPFEK
1671. THUMB POINT DRIVE
RRtTU -D LAND SU EYOR FORT PIERCE', FLORIDA 33450
FLORIDA CEAT NO 31.69 1-iu.78
FILE S .018"
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