Form DH 3145 Innovative Onsite Sewage Treatment and Disposal System Review Information Form - Florida

Form DH3145 is a Florida Department of Health form also known as the "Innovative Onsite Sewage Treatment And Disposal System Review Information Form". The latest edition of the form was released in January 1, 1994 and is available for digital filing.

Download a PDF version of the Form DH3145 down below or find it on Florida Department of Health Forms website.

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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

Download Form DH 3145 Innovative Onsite Sewage Treatment and Disposal System Review Information Form - Florida

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