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Home My WebLink AboutSUBMITTED PAPPERWORKT,CHINSON ISLAND PROPERTY A,rel ew of your submittal ST. LUCIE COUNTY PERMIT APPLICATION � � will a made for comnliaace,ice BSc • dh Si, U;CIE COUNTY PON,iic�80. CC $J Qj �1� � ( CODE T ) SEWAGE PERMIT NO. APPLICATION FOR PERMIT TO CONSTRUCT '`r�tz /B LOCATION/ADDRESS: --6� /LEGAL DESCRIPTION _� G I ��-r- ,r < i,'i ``~F SITE FLAN ROAD IMPACT: DISTRICT ZONE S/D " LOT MAP UNIT SEC BLOCK (o 9 ' Pfppw IRED )D ZONE ELEV --L NO RGE — - V-OC, e I PROPERTY TAX ID # 3�10� -(aGG - �Co I o - [nit, ZONE MPP LOT SIZE/DIMENSIONS /t�0 �( � 2 � / E T COS �d GY'%O_9a SET BACKS: FRONT N,/ REAR y'`i& SIDE ✓� �3 10 SIDE 3 (U SQ FT BUILDING: LIVING AREA ACCESSORY Radon: ARCHITECT: NAME z)A4 PHONE ADDRESS CITY ST ZIP CONTRACTOR: STATE REG'119W #''/G /C . ! O y -7 / COUNTY CERT # / b l 0 //AME /UFW/;A."/ ln,n)„'/i` F(262--'J2' ADDRESS /�.U. inns 7y'7 CITY r'• P /, c ! STATE f / i ! ��T ZIP 7 PHONE OWNER OF NAME ZZ I/A2L) 7ol' • (/�7C/ //7t' PROPERTY: ADDRESS 1/ o CITY /' � STATE OF FLORIDA, COUNTY OF ST. LUCIE STATE PHONE ZIP 7 -) �"�' Before me, the undersigned authority, personally appeared , who upon being duly sworn, deposes and says that the information contained in the foregoing apqcation is true and correct. Applicant Sworn to and subscribed before me this 7 day of rL-L-L Notary Public, State of Florida at Large SCHOOL IMPACT FEES Required 0/Yes ❑ No Amt. Pd My Commission expires: Date Pd Posted ST. LUCIE COUNTY FLOOD HAZARD NOTICE COMMUNITY DEVELOPMENT DIRECTOR ST. LUCIE COUNTY BUILDING & ZONING DIVISION 2300 VIRGINIA AVENUE FORT PIERCE, FLORIDA 34982 PHONE: (407) 468-1553 BUILDING PERMIT NUMBER 50687 CONTRACTOR Wayne Newman Construction OWNER Alvero & Victoria Valente OffemmmmD THIS NOTICE IS TO INFORM YOU THAT YOUR PROPERTY IS IN A FLOOD HAZARD ZONE. THIS MEANS THAT THE ELEVATION OF THE FLOOR MUST BE SET -AT 17 FEET, NGVD (MEAN SEA LEVEL), OR 18" ABOVE THE CROWN OF THE ROAD, IS GREATER. WHICHEVER YOU MUST SUBMIT OUR AFFIDAVIT COMPLETED BY A REGISTERED SURVEYOR,, CERTIFYING THE ABOVE FLOOR ELEVATION, WITHIN TWENTY—ONE (21) CALENDAR DAYS FROM THE TIME THE SLAB IS INSPECTED. ANY WORK DONE WITHIN THE .TWENTY—ONE (21).DAYS PRIOR TO SUBMISSION OF THE CERTIFICATION SHALL BE AT THE PERMIT HOLDER'S RISK. THE DEVELOPMENT DIRECTOR SHALL REVIEW THE FLOOD -ELEVATION SURVEY DATA SUBMITTED. DEFICIENCIES DETECTED BY THE REVIEW SHALL BE CORRECTED BY THE PERMIT HOLDER PRIOR TO FURTHER PROGRESSIVE WORK BEING PERMITTED TO PROCEED. FAILURE TO SUBMIT THE CERTIFICATION OR FAILURE TO MAKE REQUIRED CORRECTIONS SHALL BE TO ISSUE A STOP —WORK ORDER FOR THE PROJECT. G TURE 9-a2. DATE STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES )NSITE SEWAGE DISPOSAL'SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Authority: Chapter 381;, FS Chapter 10D-6, FAC Applicant Permit Number 1611 lh ------ =----- PART I = SYSTEM CONSTRUCT10 SPECIFICATIONS AND CONSTRUCTION APPROVAL------------- Septic tank or` aerobic unit i 1 gallons Septic tank or aerobic unit gallons Graywater tank gallons Laundry waste tank gallons Other Requirements: TreatmentTank Grease interceptor gallons Dosing tank gallons Minimum Draintrench Size Square Feet Square Feet Square Feet Square Feet OR Minimum Absorption Bed Size ?7S Square Feet . V Z Y'�`) Square Feet (a) Installation must be in accord with requirements of chapter 10D-6, FAC. (b) A system construction permit is valid for a period of one calendar year from date of issue. (c) Final installation inspection a d approval is required before the system is covered. f fvG (d) Invert of stub -out for Giiit v_ to bexJ`� Invert of stub -out for to be Invert of stub -out for to be _ Invert of stub -out for to be (e) Fill quality and quantity: Square Feet Square Feet benchmark. benchmark. benchmark. benchmark. LhI.HV H7"1 VLV Y1V .71" LSA l.nL,l.t�LiL RV THIS DEPARTMENT PRIOR TO DRAINFIELD INSTALLATION. "7 (f) Other: Tg AVER QV DRATN?Tr.TD—Ic GTTR.TR(-T TO SATTTRATTON FROM ROOF DRATNA(iT;. ROOF MUST BE GUTTERED PRIOR'TO FINAL APPROVAL. System design and specifications by: ' •v - 2, z '"` Title �' L 5� �f fs Constructionf uthorized by: »� Date — County Public Health Unit Note: Completed copies of this form will be provided to the applicant, installer and the building department. AUDIT CONTROL NO. 6 % 6 9 9 HR&H Fomn 4010. Feb 85 (Obsaletes priwiovs editions which may not De used) °mr�v STATE OF FLORID) DEPARTMENT OF HEALTH AND REHABILITATIVE APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRRMT �9$� Authority: Chapter381, FS ST. LUCJf�CpU 4 Chapter 1 OD-6, FAC �I (f Date of Application Permit Application Number I 1 S- -------------------------------- PART I — APPLICATION ----------- -- ------------------ Name of Owner -"4/ tl/d�� ✓C row,¢ a / ,-- �, Telephone Number Mailing Address of Owner e. 5 Y 57—. ET PC2cE FL Owner's Agent z4z4,5�4—� 4dtuz&x- Builder Agent's Mailing Address 42e V US. / F 11 Telephone No. Property Street Address Lot No. � Block No.69 Subdivision /. E ¢ 4? Date Subdivided 1/SIN. NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION This Application is for: New System_ Repair_ Type of Sewage Flow Establishment (Gallons per day) ,i1c-s�oEw r�,4L �So TOTAL FLOW = �w Type of '. No. Bedrooms Heated or Cooled Area Residential (each dwelling unit) (each dwelling unit) S/VC/E 3 I¢�Z ftz ftz Existing System Sewage Flow Based On /So CPo�6a2 No. Dwelling Sewage Flow -'- Units (Gallons per day) Exact Directions to Property�C�' `oG9�0N 1 AUDIT CONTROL NO. 66986 Applicant's Signature HRS44 Form 4015. Feb s5 (obsomm pmr ow edinam which m r not be aed) (Stock Number, 5744-M-4015-1) �• 7l �- of 3 xxxxxxxxxx�xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx WINTER CALCULATIONS xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx BASE __= i =_= AS -BUILT --------------------------------------------------------------------- GLASS------------ ; ORIEN AREA x BWPM ------------------------------------------------------------------------------- = POINTS 1 TYPE SC ORIEN AREA x WPM x WOE = POINTS N 26.0 5.6 145.6 1 SGL CLR N 26.0 9.6 1.11 277.3 E 83.0 -5.6 -464.8 1 SGL CLR E 13.0 -2.2 -0.36 10.4 1 SGL CLR - - E 40.0 -2.2 0.27 -24.2 I SGL CLR E 30.0 -2.2 -0.36 24.0 S 13.0 -14.0 -182.0 1 SGL CLR S 13.0 -10.9 0.64 -90.9 W 64.0 -5.6 -358.4 1 SGL CLR W 48.0 -2.2 -0.76 80.2 1 SGL CLR W 16.0 -2.2 -0.08 3.0 .15 x COND. FLOOR / TOTAL GLASS = ADJ. x GLASS = ADJ GLASS I GLASS AREA ------------------------------------------------------------------------------- AREA FACTOR POINTS POINTS i POINTS .15 1442.0 186.0 1.163 -859.6 -999.6 1 279.7 ------------------------------------------------------------------- - - ------ AREA x BWPM = POINTS 1 TYPE R-VALUE AREA x WPM = POINTS ------------------------------------------------------------------------------- WALLS----------- 1 Ext 954.0 1.10 1049.4 1 Ext Wood Frame 11.0 954.0 2.00 1908.0 Adj 175.0 1.80 315.0 1 Adj Wood Frame 11.0 175.0 1.80 315.0 1 DOORS----------- i Ext 20.0 5.10 102.0 1 Ext Wood 20.0 7.60 152.0 Adj 17.0 4.00 68.0 1 Adj Wood 17.0 5.90 100.3 CEILINGS---------- i UA 1442.0 0.60 865.2 1 Under Attic 19.0 1442.0 1.00 1442.0 1 FLOORS---------- i Slb 169.0 -1.90 -321.1 1 Slab -on -Grade 0.0 169.0 2.50 422.5 1 INFILTRATION--------- 1 1442.0 4.10 5912.2 i Practice #2 1442.0 4.10 5912.2 -------------------------------------- TOTAL WINTER POINTS 1 ------ 6991.1 1 10531.7 ------------------------------- - - TOTAL x SYSTEM = HEATING 1 TOTAL x CAP x DUCT x SYSTEM x CREDIT = HEATING WIN PTS MULT POINTS 1 COMPON RATIO MULT MULT MULT POINTS ------------------------------------------------------------------------------- 6991.1 1.14 ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- 7969.8 1 10531.7 1.000 1.140 1.000 1.000 12006.2 WATER HEATING BASE ___ ; __= AS -BUILT JUM OF x MULT = TOTAL I TANK VOLUME EF TANK x MULT x CREDIT = TOTAL 3EDRMS i RATIO MULT ------------------------------------------------------------------------------- 3 3527.0 10581.0 1 40 0.88 1.000 3527.0 1.00 10581.0 -- - SUMMARY BASE __= i =_= AS -BUILT _------------------------------------------------------------------------------ ::OOLING HEATING HOT WATER TOTAL i COOLING HEATING HOT WATER TOTAL POINTS + POINTS + POINTS = POINTS i POINTS + POINTS + POINTS = POINTS 14045.7 7969.8 10581.0 32596.6 ; 9963.1 12006.2 10581.0 32550.3 ***************** * EPI = 99.9 ***************** OWNER ------------------------------ I -------------- I JURISDICTION NO.: ---------------------- -------- i-------------- COMPONENT VALUE CHECKLIST STRUCTURE TYPE: Single -Family PREDOMINANT EVE OVERHANG PORCH OVERHANG WINDOWS Single Clear WALLS 1. Ext Wood Frame 2. Adj Wood Frame DOORS 1. Ext Wood 2. Adj Wood CEILINGS 1. FLAT Under Attic FLOORS 1. Slab -on -Grade DUCTS Uncond. Space COOLING 1. Central A/C HEATING 1. Strip Heat HOT WATER 1. Electric INFILTRATION Length: 2.00 Length: 5.00 Total Area: 186.0 Area: 954.0 R-Value: 11.0 Area: 175.0 R-Value: 11.0 Area: 20.0 Area: 17.0 Area: 1442.0 R-Value: 19.0 Perim: 169.0 R-Value: 0.0 Length: ALL R-Value: 4.2 SEER: 9.50 Ceiling Fan: Credit STRIP: 1.00 Bedrooms: 3 EF: 0.88 Practice: 2 Conditioned Floor Area: 1442.0 • Al BUILT POINTS / BASE POINTS * 100 = EPI ' 32550.3 32596.E 99.9 •** PRESCRIPTIVE MEASURES (Must be met or exceeded by all residences) ** ;OMPONENTS SECTION REQUIREMENTS FINDOWS 904.1 Maximum of 0.5 CFM per linear foot of operable sash crack. 'XTERIOR & 1DJACENT DOORS ------------- iXT. JOINTS & ;RACKS ------------- TATER HEATERS ----------------------------------------------------------- 904.1 Maximum of 0.5 CFM per sq. ft. of door area. Includes sliding glass doors, solid core, wood panel, insulated, or glass doors only. -------------------------------------- 904.1 To be caulked, gasketed, otherwise sealed. -------------------------------------- 904.2 ---------------------- 'WIMMING POOLS 904.3 i SPAS ---------------------- iOT WATER 904.4 ?IPES SHOWER HEADS 904.5 -------------- 3VAC DUCT :ONSTRUCTION ------------------ weatherstripped or Must bear label indicating compliance standard 90 or comply with efficiency standby loss requirements. Switch or marked circuit breaker (electric), or (gas) must be provided. An external in heat trap must be provided. ------------------------------------- w/ASHRAE and clearly cut-off or built Spas and heated pools must have covers (except solar heated). Non-commercial pools must have a pump timer. Gas spa & pool heaters must have minimum thermal efficiency of 75% ------------------------------------------------ Insulation is required only for recirculating systems. In such cases, piping heat loss shall be limited to 17.5 BTU/H/Linear Ft. of pipe. ------------------------------------------------ Water flow must be restricted to no more than 3 gallons per minute at 80 PSIG. ------------------------------------------------ 903.2 Constructed in accordance with industry 904.6 standards & local mechanical codes. Ducts in Unconditioned space must be insulated to minimum R-4.2 & joints must be sealed. ----------------------------------------------------------- iVAC CONTROLS 904.7 Separate readily accessible manual or automatic thermostat for each system. ------------------------------------------------ Ceilings-Min R-19. Common Walls - Frame R-11 or CBS R-3. Frame Common Ceilings & Floors R-11. ION REDUCTION PRACTICE COMPLIANCE CHECKLIST ** REQUIREMENTS Comply with Practice #1 and the following. ------------------------------------------------------------ & Floors Top plate penetrations sealed. Infiltration barrier installed. Sole plate/floor joint caulked or sealed. Walls & Ceilings tWork Fireplaces Exhaust Fans Combustion Appliances --------------------- Penetrations, joints and cracks on interior surface caulked, sealed, and gasketed Ductwork in unconditioned space must be sealed. Equipped with outside combustion air, doors, and flue dampers. Equipped with dampers. Combustion devices see 903.2 M . Provided with outside combustion air. ----------------------------------------------------- ---------------------------------------- In Accordance with Sec. 553.907 F.S., I Hereby certify that the plans and specifications covered by this calcu- lation are in compliance with the Florida Energy Code. )WNER/AGENT• )ATE• ---------------------------------------- Review of the plans and specifications covered by this calculation indicates compliance with the Florida Energy Code. Before construction is completed this building will be inspected for compliance in accordance with Section 553.908 F.S. BUILDING OFFICIAL: DATE: xxx�xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx SUMMER CALCULATIONS xxxxxxxxxxxxxxxxxxxxxt.xxxx*xxxxxxxxxxxxxx*x*xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx BASE __= i =_= AS -BUILT LASS------------ I ,RIEN AREA x BSPM = POINTS I TYPE SC ORIEN AREA x SPM x SOF = POINTS •------------------------------------------------------------------------------ N 26.0 47.8 1242.8 1 SGL CLR N 26.0 51.0 0.82 1081.3 E 83.0 102.0 8466.0 i SGL CLR E 13.0 109.2 0.75 1066.0 1 SGL CLR E 40.0 109.2 0.87 3780.7 1 SGL CLR E 30.0 109.2 0.75 2460.0 S 13.0 90.9 1181.7 1 SGL CLR S 13.0 100.2 0.63 825.4 W 64.0 102.0 6528.0 1 SGL CLR W 48.0 109.2 0.68 3583.3 1 SGL CLR W 16.0 109.2 0.80 1399.1 .15 x COND. FLOOR / TOTAL GLASS = ADJ. x GLASS = ADJ GLASS i GLASS AREA AREA FACTOR POINTS POINTS i POINTS ------------------------------------------------------------------------------- .15 1442.0 _------------------------------------------------------- 186.0 1.163 17418.5 20256.0 1 14195.8 AREA x BSPM i = POINTS 1 TYPE R-VALUE AREA x SPM = POINTS TALLS ----------- sxt 954.0 1.00 954.0 1 Ext Wood Frame 11.0 954.0 1.90 1812.6 kdj 175.0 0.70 122.5 1 Adj Wood Frame 11.0 175.0 0.70 122.5 1 )OORS----------- i 3xt 20.0 4.80 96.0 1 Ext Wood 20.0 7.20 144.0 kdj 17.0 1.60 27.2 1 Adj Wood 17.0 2.40 40.8 :EILINGS---------- I JA 1442.0 0.60 865.2 1 Under Attic i 19.0 1442.0 1.10 1586.2 FLOORS ---------- 51b 169.0 -31.80 -5374.2 1 Slab -on -Grade 0.0 169.0 -31.90 -5391.1 INFILTRATION--------- i 1442.0 10.90 15717.8 i Practice #2 1442.0 10.90 15717.8 _--------------------------------------- POTAL SUMMER POINTS 1 32664.5 i 28228.6 _-------------------------------------------------- POTAL x SYSTEM = COOLING I TOTAL x CAP x DUCT x SYSTEM x CREDIT = COOLING SUM PTS MULT POINTS 1 COMPON RATIO MULT MULT MULT POINTS 32654.5• 0.43 14045.7 1 28228.6 1.000 1.140 0.360 0.860 9963.1 -Y. . YYii77 TIIM C. iL-ppq Bl&N0190.71 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ,.' APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Applicant Permit Application Number —..................................... --.......... PART III - SITE EVALUATION INFORMATION -••---••-----••-- ----------•--•- 1. Lot size appears to be as indicated on site plan: Yes K No 2. Anticipated sewage flow from Part I ��y GPD Authorized sewage flow GPD 3. Benchmark location i 13//Z !�i[ ✓� 4. Existing elevation (at time of site evaluation) of the proposed system site in relation to the benchmark is 3 inches ove elow the benchmark. 5. Proposed system distance to: Surface water feet feet —meet; Private potable wells /O S is feet z feet --� feet; Community public wells '—feet feet; Other public wells — feet feet; Non -potable wells — feet —'feet; 6. Unobstructed area available for system installation /2-0 ft2 — ftz "— ftz 7. Is lot subject to frequent flooding? Yes No ,-- , 10 year flood? Yes No Pf-_ If subject to a 10 year flood indicate: (a) the 10 year flood elevation in the area feet MSL (b) property elevation at proposed system location feet MSL. SOIL PROFILE - SAMPLE SITE 1 SOIL PROFILF_ - SAMPI F CITF 9 WM mm mm mm mm USDA Soil Series Name (if Known) COLOR TEXTURE DEPTH C S'hv'a 0" toQZ' ZVc7 ;9�n „toS3„ !�3_" to -to_• to to USDA Soil Series Name (if Known) USDA Soil texture classification on which drainfield size should be based Water table at time of evaluation `' inches ow ove existing grade Type water table: Perched Apparent Are vegetative species indicative of high water table? Yes No Other findings: Estimated wet season water table inches below/above existing grade Is mottling found in the soil? Yes No At what depth? Inches Inches For property with contiguous ditches: Depth of ditches inches inches Depth of water in ditches inches inches c Date of Site Evaluation Evaluator's Signature to STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT xALE' V----- x I! L !� QRoPoSE� tiSE�Rr+1 i 1{onE' 1 \ JG pr.,'� c V%0 Q EXIgTI �G2o 7°J F. F I Ex�`�Ci NC I ��G T%rw T 0 f. Lucie County Health Unit /Environmental Health Site Plan Approved For Construction g Supercedes All Previous Site Plans oSDSM cU D/,S Reviewe ALBRITTON , FOWLER AND KIRBY INC. 608 North U.S. Highway No. I Fort Pierce, Florida 34950 2s) - V OMB 02FR•ODD26` s� FEDERAL EMERGENCY MANAGEMENT AGENCY x t NATIONAL FLOOD INSURANCE PROGRAM POST CONSTRUCTION —VATION CERTIFICATE/FLOODPROOFING CERTIFICATE COMMUNITY NUMBER St. Lucie Co,, F1. (UNINCORPORATED AREAS) 120285 INSTRUCTIONS The registered professional engineer, architect, surveyor or community permit official completes Section I below. Section Il may be completed by any of, the professionals listed at the beginning of Section II, or by a similarly qualified local permit official. Print or type the information on this form. This form is to be used for new (POST -FIRM) construction and for substantial improvements to existing structures in Zones Al-A30, AH and V1-V30 and existing (PRE -FIRM) buildings to be rated under POST -FIRM rules and rates, SECTION I (TO BE COMPLETED BY COMMUNITY PERMIT OFFICIAL) ROPERTY ADDRESS (or lot and block numbers t address Is unavailable) Owner: Alvaro & Victoria Valente 5910 Birch Drive INDIAN RIVER ESTATES (NAME: Wayne Newman ConstructiorBP# 50687 ) A MAP PANEL ON WHICH PROPERTY IS LOCATED FIA MAP ZONE IN WHICH PROPERTY IS LOCATED 281 AH A MAP EFFECTIVE DATE BASE FLOOD ELEVATION AT THE PROPOSED SITE January 5, 1984 17 TART OF CONSTRUCTION DATE Name and Tide ._ ._._ . PHONE (with Area Code) 9/89 Terry L. Virta-Community Development Director )DRESS 2300_Virginia Ave., Ft, Pierce, F1. 33450 September 11, 19 Date (� C SECTION II INSTRUCTIONS Complete only the Elevation, Certification unless the building has been floodproofed at least to the base flood elevation. If floodproofing is used, complete only the Floodproofing Certification. The Elevation Certification may be completed by a registered professional engineer, architect, or surveyor. The Floodproofing Certification may only be completed by a registered professional engineer or architect. _ ELEVATION CERTIFICATION I certify that t building the property location described above has the lowest floor at an elevation of ,act, 21 .23 i / feel, NGVD (mean sea level). l FLOODPROOFING CERTIFICATION I certify to the best of my knowledge, information, and belief; that the structure is designed so that the structure is watertight to an elevation of feet NGVD (mean sea level), with wails substantially impermeable to the passage of water and structural components having the capability of resisting hydrostatic and hydrodynamic loads and effects of buoyancy that would be caused by the flood depths, pressures, velocities, impact and uplift forces associated with the base flood. In the event of flooding, will this degree of floodproofing be achieved with human intervention?* Will the structure be occupied as a residence? Yes If the answer to both questions is Yes, the floodproofing cannot be credited for rating purposes and the elevation certification must be completed instead. 'Floodproofed with human intervention means that water will enter the structure when floods up to the base flood level occur, unless measures are taken prior to the flood to prevent entry of water (e.g. bolting metal' shields over doors and windows). :RTIFIER'S NAME John G. Albritton AFFIX SEAL OR,WRITE>PROFESSIONAL LICENSE'NQ,:�EtOW"\ ' �ithtt i TIC Land Surveyoro`Ire, R lr/ DDRRegistered 608 North U. S. Highway 1 Fort Pierce, Florida 34950 1rl41�al ,,ycoIV h (Signature) (Date) Fla. Reg. No. v The insurance agent attaches the second copy of the completed form to the flood insurance policy application for new (POST -FIRM) construction or substantial improvements. Be sure,lhat the second copy Is certified. Vc'VISEu CJ UG l�Lvi�t c� i STATE OF FLORIDA •� DEPARTMENT OF HEALTH. AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT f� 1 Gv, d hz�/ D�1 U E (cao / Tz/W� �n m a�zr ,aBo�E� i F7ro�arED" 5Ti �G y°6� Too. EM6N7 /�/`y't. L K;e County Health 'J'it Em.;rsnmeritc;I He31th c e r=1 ❑ Appr%'� '; F r C x�str�ction up�:.edes All Yrevoas site, Flans Reviewer — t Zx,� ALBRITTON , FOWLER AND KIRM 608 North U. S. Highway No. I