HomeMy WebLinkAboutSUBMITTED PAPERWORKi
STATE OF FLORIDA
DKFWMENT OF HEALTH AND REPASH1TAIRM SKRVIC fe
DIVISION OF HEALTH '
/wl 0"Ir .ci Qj° Jw4wn,pa. /MNe DaJ°1
Application and Permit
of
Tndividual Sewage Disposal Facilities
Applicati n/Permit
No. L St. Lucie County
Section I - Instructions:
. Percolation test ata, soil pro-
file and water table elevation
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.
' a: ... tom':%ri•
A.
Health Department."= •;j ;'
5. Indicate name and date of plat
of subdivision. if not platted,,
attach metes and bounds description.
6). Complete the following infor-
mation section.
Notes: r,.
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.
A
Section II - Information: '
1. Property Address Street & House No.) off Hartman Rd.
Lot Block Subdivision an a woo
Date Platted Directions to Jo y'
+ 200' tiVd-g T ffn South on private road
2. Owner or Buiiaer _N
P.O-. Address City__
Septic tank system die insta
3. Specifications:
gallon tank with
p�N� square feet of
dra h eld with at least
4" inside diameter pipe.
4. House to be constructed:
Check one: FHA
vA __)L_Conventional
This is to certify that the
project described in this
application, and as detailed
by the plans and specifica-
tions and at•tachmd.lte Mill be
constructed in accordance with
state requirements.
I n ,� 1
Applicant: A4-4-VN .IAY
P se Print
Signature v,
scale 1" a 50'
(Rear)
SCANNE®
BY
St. Lucie County
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DRAINFIELD TO BE INSTALLED
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TN RCA SPECIFIED &LF� o
ouse or an alwood z
a uet Club P)
0, P4
Front
(Nalue of Street or State goad) •ir
Dates _'�Nril 28. 1978 �:
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####*###t***#xa***#t4*R DO NO WRITE BELOW THIS LINE ##*#***#*a#*utr#d11t9tY - .'i
Section III - Application A roval & Construction Authorizatio ,•I
Ins- atioG,G�u �n t• fog owing p is hdxt ons:
i Lt
he above signed application has Been found o be i compliance' 1
with Ch er 1OD-6, Florida Administrative Code, and constructicn
is her a proved, ject to the above speeif' io s and Iona
Count Health Dept.
Date
By! y J p* a* 1
Section IV - nal Construction Approval
Construction of installation approved: Yes No
Date. By;
FHA No. A c.
C F S end. ASSOCIATES; I� .
SAN 428 k, .�I`•
REV. 3/75
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4a,,,,uP a.. �iGa'. ly u %e,
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tD
o THIS PERMIT EXPIRES ONE (1)
YEAR FROM DATE OF ISSUANCE
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P. 0, Box 1449.
Fort Pierce, Fla.' 334507.