Loading...
HomeMy WebLinkAboutD.O.H. PAPPERWORKHof STATE OF FLORIDA !� ,s DEPARTMENT OF.HEALTH ONSITE SEWAGE TREATMENT SYSTEM APPLICATION FOR CONSTRU APPLICATION FOR: [ ] New System [ ] Existing System [ ] Repair [ ] Abandonment APPLICANT: James D. and Linda E. Totton AGENT SCANNED BY St. Lucie County AND DISPOSAL PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: [ ] Holding Tank [ ] Innovative [ ] Temporary [ ✓ ] Addition TELEPHONE: (772) 577-0726 MAILING_ ADDRESS . 970 Bay Drive, Summerland Key, FL 33042 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. PROPERTY INFORMATION LOT: 15 BLOCK: 78 SUBDIVISION: Lakewood Park=Unit 7 PLATTED: 0112511961 PROPERTY ID #: 1301-607-0218-000-1 ZONING: RS-4 I/M OR EQUIVALENT: [ Y/© ] PROPERTY SIZE: 0.29 ACRES WATER SUPPLY: [ ✓] PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ NO ] DISTANCE TO SEWER: N/A FT PROPERTY ADDRESS: 6511 Fort Pierce Blvd., Fort Pierce, FL 34951 DIRECTIONS TO PROPERTY: I-95 north to Indrio Road, east to Fort Pierce Blvd., north to property. BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of No Establishment Bedrooms I Single Family Home 2 2 3 4 Building Commercial/Institutional System Design Area Sqft Table 1, Chapter 64E-6, PAC 1104 No bedrooms added [ ] Floor/Equipment Drains [ ] Other (Specify) SIGNATURE: Q��ur�pG�� DATE: r DR 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH p ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: [ ] New System [ ] Existing System [ ] Bolding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ✓ ] Addition APPLICANT : James D. and Linda E. Totton AGENT: MAILING ADDRESS: 970 Bay Drive, Summerland Key, FL 33042 TELEPHONE: (772) 577-0726 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. PROPERTY INFORMATION LOT: 15 BLOCK: 78 SUBDIVISION: Lakewood Park - Unit 7 PROPERTY ID #: 1301-607-0218-000-1 PLATTED: 01/25/1961 ZONING: RS-4 I/M OR EQUIVALENT: [ Y/© 1 PROPERTY SIZE: 0.29 ACRES WATER SUPPLY: [ ✓] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ NO ] DISTANCE TO SEWER: N/A FT PROPERTY ADDRESS: 6511 Fort Pierce Blvd., Fort Pierce, FL 34951 DIRECTIONS TO PROPERTY: I-95 north to Indrio Road, east to Fort Pierce Blvd., north to property. BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area Sgft Table 1, Chapter 64E-6, FAC 1 Single Family Home 2 1104 No bedrooms added 2 3 4 [ ] Floor/Equipment Drains [ ] Other (Specify) .+ SIGNATURE: DATE: /Z)/17/� J DR 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4