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<br /> <br />CENTRAX #: 51-SE-13320 <br />DATE PAID: <br />FEE PAID $ if 5" / 'tJ <br />RECEIPT <br />OSTDSNBR 03-1943--N <br /> <br /> <br />STATE OF FLORIDA <br />DEPARTMENT OF HEALTH <br />ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM <br />CONSTRUCTION PERMIT <br /> <br />CONSTRUCTION PERMIT FOR: <br />[ X ] New System [ ]Existing System <br />[]Repair []Abandonment <br /> <br />] Holding Tank <br />] Temporary <br /> <br />Innovative Other <br />Modification <br /> <br />APPLICANT: Johnson, Pam <br /> <br />AGENT: 0864, Bozeman Steve <br /> <br />PROPERTY STREET ADDRESS: 6th Street Zephyrhills FL 33541 <br /> <br />LOT: 0010 BLOCK: 0 SUBDIVISION: Zephyrhills Colony C <br />[Section/Township/Range/Parcel No.] <br />PROPERTY ID #: 1226210290000000010 [OR TAX ID NUMBER] <br /> <br />SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E-6,FAC <br />DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME <br />PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, <br />REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS <br />PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM <br />COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. <br /> <br />SYSTEM DESIGN AND SPECIFICATIONS <br /> <br />T 900] Gallons SEPTIC TANK MULTI-CHAMBERED/IN SERIES: [Y <br />A 0 ] Gallons MULTI-CHAMBERED/IN SERIES: [Y <br />N 0 ]GALLONS GREASE INTERCEPTOR CAPACITY <br />K 0] GALLONS DOSING TANK CAPACITY [ 0] GALLONS @ [0 ] DOSES PER 24 HRS # PUMPS [ 0 <br /> <br />D 333 ]SQUARE <br />R [ 0 ] SQUARE <br />A TYPE SYSTEM: <br />I CONFIGURATION: <br />N <br />F <br />I <br />E <br />L <br />D <br /> <br />FEET PRIMARY <br />FEET <br />[ N ] STANDARD <br />[ Y]TRENCH <br /> <br />DRAINFIELD SYSTEM <br />SYSTEM <br />[ Y ] FILLED <br />[ N ]BED <br /> <br />N ] MOUND <br />N] <br /> <br />[ N ] <br /> <br />LOCATION TO BENCHMARK: Steel Nail W/Oranqe Ribbon On Live Oak North of Septic <br />ELEVATION OF PROPOSED SYSTEM SITE [ 39.0 ] [INCHES [BELOW]BENCHMARK/REFERENCE POINT <br />BOTTOM OF DRAINFIELD TO BE [49.0] [INCHES [BELOW] BENCHMARK/REFERENCE POINT <br /> <br />FILL REQUIRED: <br /> <br />8.0 ]INCHES <br /> <br />EXCAVATION REQUIRED: <br /> <br />0.0 ] INCHES <br /> <br />JTHER REMARKS: <br />rhe licensed contractor installing the system is responsible for installing the minimum <br />~ategory of tank in accordance with s. 64E-6.013(3) (f), FAC. <br />ESE] Sized for 3 bedroom 1610 sq ft house. Connect to central water. <br />A copy of the building department per.mit showing the assigned address must be submitted to <br />the Dade City office. <br />Stub out needs to be 34" below reference point for gravity flow. <br /> <br />;PECIFICATIONS BY: Hindalong, Jeff <br /> <br />TITLE: EH Specialist II <br /> <br />~ <br /> <br />,PPROVED BY: Hindalong, Jeff 1~ ~ <br /> <br />lATE ISSUED: 12/9/03 <br /> <br />TITLE: EH Specialist II <br /> <br />Pasco <br /> <br />CHD <br /> <br />EXPIRATION DATE: 6/9/05 <br /> <br />'H 4016, 03/97 (Obsoletes previous editions which may not be used) <br />Stock Number: 5744 -001-4016 -0) [ostds_cons_4016~l] <br /> <br />Page 1 of 2 <br />