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50 NE 93 St (10)STATE OF F:_.;ORi DA DEPARTMENT OF HEALT AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Mr. itt Permit Number _CO At. r, 93 s > PAR li - SYSTEM INS`':AL Gx'ION :NS ECTdO :` AND iNAL !f4S`'uALLA`� ION APPI OV. _....< lnstalier Applicant aropertank legend: Yes_ J* No - 'a.nswatertight: Yes_ / /// No 1 Dr€t'•s ` :renen . ;RS —H Form 4016, Feb 85 (Obso!ates previous editions which may not be used) Stock Number. 5744.002. 4016.0) AN A' :TROVi -•;'D :INSTALLATION DOES NO`l GUARANTEE PERFORMANCE Tank Manufacturer �•an': material ,k ;)�1, y; _ •'ank !evel: Yes „' - No ", ank size: 67/4 gallons gallons gallons Loper tank outlet device: Yes Nc _ Vanl or marker to grace: Yes "sorption BEd Length `q d ° Meet x — feet =_ width feet Length feet x feet Proper No. drainlines: Yes feet feet _ feet '!'wet -- feet feet feet _ 'eet feet feet ft •'�• = ft �'ys >c rs located es permitted: Yes " Sys,e :s inc:ud : :ng plumbing st'J'c -cuts installed at proper elevation: Yes i&hNo t p e r. a h Fay.,rag;, depth ,., dra.�n )per i..v„� from finaa.ea g.ac'e: �/,) inches Maximum depth: :; Inc :yes Ave depth of drainfield gravel :,J( ''canes Minignum dept's of gravel inches :):c"er grave: size: Yes No Gravel is suitable quality: Yes �� No e; r feet= ft Proper pipe separation: Yes .V No Distribution box level: Ye.; ~.ckfi.l o" fi:i ^aterial as required: (Quality) 'k s NO - (Quanti y) Yes r4h 7. . '" �; F <�� !' "� y�a4�6'�I /„',? .fW'�J �I ncYr�gs. � ,� 5 :�-��� N,, z �I� k r :spected by: b ?, c14 S� ' Date --- %% FINAL IN INS TALLATION APPROVAL- ...... -_ ©____ -a___ _- __a ........... Approved by: �'./ , k / COUNTY UBLIC HEALTH UNIT N:;;::^: Completed copies of this fora will be provided to the applicant, installer and the building c:epartment. Page 2 of 2