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<br />STATE OF FLORIDA <br />DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES <br />ONSITE SEWAGE DISPOSAL SYSTEM <br />CONSTRUCTION PERMIT <br />Authority: Chapter 381, FS & Chapter 10D-6, FAC <br /> <br />PERMIT # <br />DATE PAID <br />FEE PAID <br />RECEIPT # <br />STREET <br /> <br />95-6777-EAST <br />/ / <br />$ 0.00 <br /> <br />CHARTER ST <br /> <br />CONSTRUCTION PERMIT FOR: <br />[ ] New System [X] Existing System <br />[ ] Repair [ ] Abandonment <br /> <br />Holding Tank <br />Other(Specify) <br /> <br />[ ] Temporary/Experimental System <br /> <br />APPLICANT: GEORGE STRAKA <br /> <br />AGENT: <br /> <br />PROPERTY STREET ADDRESS: 4712 CHARTER ST <br /> <br />ZEPHYRHILLS <br /> <br />LOT: 0390 <br /> <br />BLOCK: <br /> <br />SUBDIVISION: EDGEWOOD <br /> <br />PROPERTY ID #: 14-26-21-0270-00000-0390 <br /> <br />[SECTION/TOWNSHIP/RANGE/PARCEL NO.] <br />[OR TAX ID NUMBER] <br /> <br />__:...a..___==___==_.=:=_=========:==========::====_==._==_.==_==_=====_==_=_=____......_:===___ <br /> <br />SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 100-6, FAC <br />REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS <br />EXPIRE 18 MONTHS FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY <br />PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A <br />BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH <br />MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. <br /> <br />========-====-=====================================================_==:a======================== <br /> <br />SYSTEM DESIGN AND SPECIFICATIONS <br /> <br />T <br />A <br />N <br />K <br /> <br />900 <br />o <br />o <br />o <br /> <br />[ GPD ] AEROBIC UNIT CAPACITY <br />[GALLONS / GPD] <br />GALLONS GREASE INTERCEPTOR CAPACITY <br />GALLONS PER DOSE <br /> <br />MULTI-CHAMBERED/IN SERIES: [ ] <br />CAPACITY MULTI-CHAMBERED/IN SERIES: [ ] <br />[MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] <br />DOSE RATE [0] PER 24 HRS NO. OF PUMPS: [0] <br /> <br />D <br />R <br />A <br />I <br />N <br />F <br />I <br />E <br />L <br />D <br /> <br />333 SQUARE FEET PRIMARY <br />[ 0 ] SQUARE FEET <br />TYPE SYSTEM: <br />CONFIGURATION: <br /> <br />STANDARD <br />TRENCH <br /> <br />DRAINFIELD SYSTEM <br />SYSTEM <br />[ ] FILLED <br />[ ] BED <br /> <br />MOUND <br /> <br />LOCATION OF BENCHMARK: <br />ELEVATION OF PROPOSED SYSTEM SITE IS <br />BOTTOM OF DRAINFIELD TO BE <br /> <br />0.0 <br />0.0 <br /> <br />INCHES <br />INCHES <br /> <br />BENCHMARK/REFERENCE POINT <br />BENCHMARK/REFERENCE POINT <br /> <br />FILL REQUIRED: [ 0.0 ] INCHES <br /> <br />EXCAVATION REQUIRED: [ 0.0 ] INCHES <br /> <br />o <br />T <br />H <br />E <br />R <br /> <br />SPECIFICATIONS BY: Ivan Rodriguez <br /> <br />TITLE: E.S. I <br /> <br />APPROVED BY: Ivan Rodriguez <br /> <br />TITLE: E . S . I <br /> <br />PASCO <br /> <br />CPHU <br /> <br />DATE ISSUED: 12/05/95 <br /> <br />EXPIRATION DATE: 12/04/96 <br /> <br />HRS-H Form 4016 March 1992 (Obsoletes Previous Editions Which May Not Be Used) <br /> <br />Page 1 of 2 <br />