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APP DOC #AP1193313
< STATE OF FLORIDA PERMIT #: 56-SF-1613275
V DEPARTMENT OF HEALTH DATE PAID 06/18/2015
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT FEE PAID: 655.00
RECEIPT #:56-PID-2695812
APPLICATION FOR:
[ ] New System [ ] Existing System [ ] Holding Tank [ ] Innovative
[ ] Repair [g] Abandonment [ ] Temporary I l
APPLICANT: State of FL. Dept. of Transportation
AGENT: Ronnie Meeks(Meeks Plumbing Inc) TELEPHONE: 1 (772)460-2850
MAILING ADDRESS: 5555 US Hwy 1 Vero Beach, FL 32967
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 REPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED
(MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
LOT: BLOCK:
SUBDIVISION: PLATTED:
PROPERTY ID #: ZONING: I/M OR EQUIVALENT: [ Y IN '
PROPERTY SIZE: 1.83 ACRES WATER SUPPLY: [ ]PRIVATE [ ]<=2000GPD [ 1>2000GPD
IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y ED DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 2221 W Midway Rd Fort Pierce, FL 34982
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION: [ ] RESIDENTIAL [g] COMMERCIAL
[ ] Floor/Equipment Drains [ ] Other (Specify)
SIGNATURE: DATE: 06/18/2015
DH 4015, 08/09 (Obsoletes previous editions which may not be used)
Incorporated 64E-6.001, FAC Page 1 of 4
V 1.0.0 AP1193313 EID1613275