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St. Lucie County Health Department
HEALTH 5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON:
PERMIT#:56-SF-1647912 BILL Doc#:56-BID-2993794 CONSTRUCTION APPLICATION#:AP1216274
RECEIVED FROM: ASHTON SEPTIC TANKS, INC. AMOUNT PAID: $ 65.00
PAYMENT FORM: CREDIT CARD PAYMENT DATE: 12/11/2015
MAIL TO: Geroge Jones
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FACILITY NAME :
PROPERTY LOCATION:
1817NUSHwy
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Fort Pierce, FL 341946
Lot: Block:
Property ID: 2403-602-0062-000-3
EXPLANATION or DESCRIPTION: QUANTITY FEE
-1 - Surcharge(All) 1 $ 15.00.
134-OSTDS Construction Abandonment Permit.and Inspecti 1 $ 50.00
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RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-2860368
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St. Lucie County Health Department
ROM 5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: PERmrT#:56-SF-164789 BILL Doc#:56-BID-2993748 CONSTRUCTION APPLICATION#:AP1216258
RECEIVED FROM: ASHTON SEPTIC TANKS, INC. AMOUNT PAID: $ 65.00
PAYMENT FORM: CREDIT CARD PAYMENT DATE: 12/11/2015
MAIL TO: George Jones
FACILITY NAME :
PROPERTY LOCATION:
908 Valley Ln I
Fort Pierce, FL 34946
Lot: 47 Block:
Property ID: 2403-6027-0048-000-9
EXPLANATION or DESCRIPTION: QUANTITY FEE
-1 -Surcharge(All) 1 $ 15.00
134-OSTDS Construction Abandonment Permit and Inspecti 1 $ 50.00
RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-2860291'
STATE OF FLORIDA PERMIT NO.
DEPAIMMM OF EEALTH -DATE PAID:
ONSITE- SEABGE TRAM AND DISPOSAL FEE PAID:
SYSTM RECEIPT :
APPLICATION FOR CONSTRUCTION PMOUT
APPLICATION FOR:
I N0P! m [ I Existing System. j J Bo2cUng tank L I Mmao native,
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Repair Aban&x&m9„t Temporalw L 3
APPr�CA�aT: I � �
AST: ask _ ► 5,.� ti, `�►� _�n � :
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r=lNG Ai3DREss:
od BE COM METED BY APPLICANT OR APPI:ICANT"S AUTHORIZ8D A90T_ SYSTEMS'MUST BE CONSTRUCT®
BY .A PERSON LICENSED MISUANT TO 489_105(3) (m) OR 489_552, FLORI X SSS. IT.IS ±M
APP.I,ICMTI S RESPONSIBILITY TO PROVIM DOC �`p' loft OF TEE DAIS THE LOT AAS C&ATED OR
PT A'1'2'ED WDDIYY) IF REQUESTM- G-CONSIDM TION OF STBTOMRY PR VISIONS_
PROPERTY =NFD!EtNATION
LOT: BLOCK: SUBDIVISION: �i� r5,le � ETA :
VWV9P2s is #z 1. Y A 1)Z" M(62-OW -3 OOHING: ('r 6 f/M OR EQUIVALENTL Y / N 3
XWEER Y Ste: I }•� ACRESVULTER, SUPPLY: ><PRIvATE PUBLIC.�L I<=2000M L 3>2000GPD
IS SEfniEEt AVAILABLE .AS PER 381_0065, FS? L Y IrN - -DISTANM TO SEMI:._—W FT
--ROPZkW ADDRESS: 06 }-}-w
DIRECTIONS O PERSY: V w
BUILDING INFcMQA i ON P< RESIDENTIAL L ) G09fidERCIAL _
Unit' ape bf I No_ of Bio;ng Commerciaul./Institutional System Design
No Establishment Bedrooms .area Scift Table 2, Chapter 64E-6, EAC
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L I FloawJEanipm I� t Dra-i s L ] Other (sPecixY')
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.DH 4015 0$I (Obsoletes piev3ous edi.tlons which may not be used)
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