HomeMy WebLinkAboutProject Information Rick Scott
no= Governor
to protect,promote S improve the health
of all people in Florida through integrated FNM1 Celeste Philip,MD,MPH
state,county&community efforts_ . _ HEALTH
L TH Interim State Surgeon General
Ylsfon:To be the Healthiest State in the Nation
May 06,2016
RECER"7D JUN 2 8 7.036
Kimberly Evans �� P y
1214 W Joy Lane
Fort Pierce, FL 34945
RE: Contingency Letter
Application Document No:API 238547
Centrax Permit Number: 56-SF-1680706
OSTDS Number:
_1214 W Joy Ln
Fort Pierce, FL 34945
Lot:28 Block:A Subdivision:Avon Manor
Dear Applicant:
This will acknowledge receipt of an application dated 05/06/2016 for a permit to use an
existing onsite sewage treatment and disposal system located on the above referenced
property.
From a review of your completed application, it has been determined that your existing system
appears to meet the minimum standards of F.A.C. 64E-6 for the proposed use. It is approved
for use with the plans submitted to this office. If this system should fail,causing an unsanitary
condition to exist,steps must be taken to bring the system into compliance immediately.
Department approval of the system does not guarantee satisfactory performance for any
specific period of time.Any change in material facts which served as a basis for issuance of
this approval requires the applicant to modify the permit application.Such modification may
result in this approval being.made null and void. Issuance of this approval does not exempt the
applicant from compliance with other Federal, State, or Local Permitting required for
development of this property.
If you have any questions on this matter, please call our office at(772)873-4931.
Sin re
Victor Faconti, Env.Sup 11
Enclosures
CC.
Florida Department of Health www.FloiidasHealth.com
in ST.LUCIE COUNTY TWITTER:HealthyFLA
"-5150 NVtfMlner Dr,Port Saint Lucie,FL 34983 FACEBOOK
FLDepartrrrentofl-lealth
PHONE:(772)873.4931.FAX:(772)873-4893 YOUTUBE:tidoh
REGEMH JUN 2 70116
10 Py
blata
STATE OF X.TAMIDA EEMIXT NO-
OF. DATE PAID: 35
-,.
ONSITE. SLWAGM TREATMM AND DISPOSAL FEE PAID'. ?A-9�..
obaz�"
SYSTEMA.
YSTEM RECEIPT :
APPLZMATZON FOR- CONSTRUCTIQN' PERMIT
APPLICATION FORd
[ ]` New-A-Ys Existing System ( ] Holding Tank [ ] Innovative
Abancto»nicnt [ ] Temporary [;/7 PIAN ItfiYIEW
APPLICANT:. oN,
AGENT: TELEPHONE: 4(a(— S7 4-7
MAYI,ING ADDRESS.- t 1.4 in t 5ri)�r 1�-n Pt P c gC.��, PL 3qC1 lis—
TO
iSTO BE. COMPLETED BY APPLICANT OR.APPLICANT'S AUTHORIZED AGENT. SYSTEMS MAST HE- CONSTRgCTED
BY A PERSON 'LICENSED PURSUANT TO 489.105:(3) (m) OR 459.55,2-, I;ORI_D14 STATUTES. IT IS THE
AE!PiitiNTrS :RES PONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED .OR
]7LATTED (bWDD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS.
PROPERTV 21&ORMAT,I0N
MOT a� BLOCK!- A sumnasION: A mon /4Cfaor -UPLATTED:.
PROPERTY ID.. a 3.a3~l !ODDa B-ODD-1 z0NirrG.; M14.5 I/M OR EQUIVMzft c E Y 7 N ]
PROPERTY SIZE: 0,23 ACRES WATER SUPPLY: [ ] -PRIVATE PUBLIC- [ ]<=2000GPD [ ]>2000r.#D
IS .SEWER AVAILABLE AS PER 381.0065, FS? [ YIN 7 DISTANCE TO SEWER: FT
PROPERTY ADDRESS: 121.1 L4. W JOY 1.-.-n PH P t of c f- F&- 3T 'y5
DIRECTIONS TO PROPERTY: u} e-6 (J r 1 Rn%i e.
BUILDING INFORMATION [✓] RESIDENTIAL [ ] COMMERCIAL
-Unit Type of No. of .Building Commercial/Institutional System Design
Na Establishment. Bedrooms Area Sgft Table 1, Chapter 64E-6, FAC
ao
2
3�
4
[ ] Floor/Equipment Drains [ ] Other (Specify)
SIGNATuRti '�F DAVE.:
DH 4055, 08/0 (Obsole es previous editions which may not be used)
-Incorporated 64E-6..001, FAC Page 1 :of 4