Form DH3145 "Innovative Onsite Sewage Treatment and Disposal System Review Information Form" - Florida

What Is Form DH3145?

This is a legal form that was released by the Florida Department of Health - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 1994;
  • The latest edition provided by the Florida Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form DH3145 by clicking the link below or browse more documents and templates provided by the Florida Department of Health.

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Download Form DH3145 "Innovative Onsite Sewage Treatment and Disposal System Review Information Form" - Florida

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INNOVATIVE ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM REVIEW INFORMATION FORM
TO BE COMPLETED BY COUNTY HEALTH DEPARTMENT
CONSTRUCTION PERMIT APPLICATION NUMBER:
Property Owner:
(Last, First, M.I. or Business Name)
Property Address:
(Physical Location or Street Location)
Mailing Address:
(Street Address or P.O. Box)
Owner's Agent:
Mailing Address:
(Last, First, M.I. or Business Name)
(Street Address or P.O. Box)
(City)
(State)
(Zip)
PROVIDE THE FOLLOWING INFORMATION FROM SITE EVALUATION AND
PROPOSED CONSTRUCTION PERMIT AND ATTACH A COPY OF THE SITE PLAN:
Septic tank(s):
Public water supply: .................................. Y / N
gal.
Estimated sewage flow:
Dosing tank(s):
gpd
gal.
Aerobic treatment Unit(s):
Lot size:
sq.ft.
DESCRIPTION OF INNOVATIVE SYSTEM AND COMPONENTS:
FOR STATE HEALTH OFFICE REVIEW ONLY
Date received:
Review form complete: .............................................. Y / N
Additional information requested: .........................................Y / N
Date:
Brief explanation of information requested:
Application:
Approve
Disapprove Reason:
Reviewed by:_____________________________________________
Site Number______of_______approved sites.
Date:_______________
DH Form 3145, 1/94 Incorporated: 64E-6.004, FAC
INNOVATIVE ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM REVIEW INFORMATION FORM
TO BE COMPLETED BY COUNTY HEALTH DEPARTMENT
CONSTRUCTION PERMIT APPLICATION NUMBER:
Property Owner:
(Last, First, M.I. or Business Name)
Property Address:
(Physical Location or Street Location)
Mailing Address:
(Street Address or P.O. Box)
Owner's Agent:
Mailing Address:
(Last, First, M.I. or Business Name)
(Street Address or P.O. Box)
(City)
(State)
(Zip)
PROVIDE THE FOLLOWING INFORMATION FROM SITE EVALUATION AND
PROPOSED CONSTRUCTION PERMIT AND ATTACH A COPY OF THE SITE PLAN:
Septic tank(s):
Public water supply: .................................. Y / N
gal.
Estimated sewage flow:
Dosing tank(s):
gpd
gal.
Aerobic treatment Unit(s):
Lot size:
sq.ft.
DESCRIPTION OF INNOVATIVE SYSTEM AND COMPONENTS:
FOR STATE HEALTH OFFICE REVIEW ONLY
Date received:
Review form complete: .............................................. Y / N
Additional information requested: .........................................Y / N
Date:
Brief explanation of information requested:
Application:
Approve
Disapprove Reason:
Reviewed by:_____________________________________________
Site Number______of_______approved sites.
Date:_______________
DH Form 3145, 1/94 Incorporated: 64E-6.004, FAC