HomeMy WebLinkAboutD O H PAPERWORKI
_ STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
APPLICATION FOR:
[ ] New System [X ]
[ ] Repair [ ]
APPLICANT: David F. Mc
AGENT: Cvndee Underhill dba
JAN 2 3 20N
MAILING ADDRESS: PO Box 776 Starke FI 32091
County, Permittino
PERMIT NO.
DATE PAID:
FEE PAID:
RECEIPT #5
-'V Co A�
Tank [ ] Innovative 4n`Yr
y [ ]
TELEPHONE: (352) 468-1116
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED
BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE
APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR
PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
1!kks2�-AZkWRaVie) 03441F{0)zI
LOT: 69 BLOCK: SUBDIVISION: Treasure Coast Airoark PLATTED:
PROPERTY ID #: 4224-501-0069-000-9 ZONING: AG-5 I/M OR EQUIVALENT: [ Y / N ]
PROPERTY SIZE: 4.8 ACRES WATER SUPPLY: I
PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y /IN1] DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 1537/5�SkylkinO Drive, Port St. Lucie( / L
FL / 34987
DIRECTIONS TO PROPERTY: ]I i t it W-11 In 9 �i. '�F 4 1) .4 A
BUILDING INFORMATION
Unit Type of
No Establishment
1 60x6O Partial Enclosed
RECEIVED
3
4 -
RESIDENTIAL [ ] COMMERCIAL
No. of Building Commercial/Institutional System Design
Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC
- 0 3600
Other (Specify)
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC
jbpermitsfl@gmail.com
DATE: I a 3 l- 19
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