Form DH3146 "Citation for Violation Onsite Sewage Program/Sanitary Nuisance" - Florida

What Is Form DH3146?

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 November 1, 2002;
  • 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 DH3146 by clicking the link below or browse more documents and templates provided by the Florida Department of Health.

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Download Form DH3146 "Citation for Violation Onsite Sewage Program/Sanitary Nuisance" - Florida

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STATE OF FLORIDA
DEPARTMENT OF HEALTH
CITATION FOR VIOLATION
ONSITE SEWAGE PROGRAM/SANITARY NUISANCE
Authority: 381.0065 Florida Statutes
Person being cited
Address of alleged violation
(street address)
Address of person being cited
Address
(street address)
(city, state, zip)
Address
Date and Time of Citation (M/D/Y); a.m./p.m.
(city, state, zip)
Business Name
Name of Citing Inspector
(if applicable)
PART 1.
CITATION OF LAW AND/OR RULE VIOLATIONS
Write particular nature of violation, including specific reference to the provisions of law and/or rule allegedly violated.
Law
Rule
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
PART 2.
DESCRIPTION OF VIOLATIONS
Describe any violations observed, along with the date and time observed.
PART 3.
PRELIMINARY NOTICE
Date of initial notice of violation:
Type of notice given:
Inspection report
Notice of violation
Other (specify)
Notice issued by:
,
County Health Department
PART 4.
FOLLOW UP VISIT
Date of reinspection
Reinspection by:
,
County Health Department
NOTICE OF APPELLATE RIGHTS ON REVERSE
DH 3146, 11/02
Page 1 of 2
Obsoletes previous editions which may not be used. Incorporated: 64E-6.001, FAC
STATE OF FLORIDA
DEPARTMENT OF HEALTH
CITATION FOR VIOLATION
ONSITE SEWAGE PROGRAM/SANITARY NUISANCE
Authority: 381.0065 Florida Statutes
Person being cited
Address of alleged violation
(street address)
Address of person being cited
Address
(street address)
(city, state, zip)
Address
Date and Time of Citation (M/D/Y); a.m./p.m.
(city, state, zip)
Business Name
Name of Citing Inspector
(if applicable)
PART 1.
CITATION OF LAW AND/OR RULE VIOLATIONS
Write particular nature of violation, including specific reference to the provisions of law and/or rule allegedly violated.
Law
Rule
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
Citation:
Violation:
PART 2.
DESCRIPTION OF VIOLATIONS
Describe any violations observed, along with the date and time observed.
PART 3.
PRELIMINARY NOTICE
Date of initial notice of violation:
Type of notice given:
Inspection report
Notice of violation
Other (specify)
Notice issued by:
,
County Health Department
PART 4.
FOLLOW UP VISIT
Date of reinspection
Reinspection by:
,
County Health Department
NOTICE OF APPELLATE RIGHTS ON REVERSE
DH 3146, 11/02
Page 1 of 2
Obsoletes previous editions which may not be used. Incorporated: 64E-6.001, FAC
PART 5.
ACTIONS TAKEN TO CORRECT VIOLATIONS
List any actions the property owner has taken to correct the violations.
PART 6.
ORDER OF CORRECTION/FINE AND PAYMENT
The person named in this citation is hereby ordered to correct the violation(s) listed in Part 1 within
days
of the service of this citation.
The person identified on this citation is hereby directed to pay a fine in the amount of $
for
the violations listed in Part 1. Payment must be made to the
County Health Department within 21 days of the receipt of this citation, or you may choose the option listed in
Part 9.
PART 7.
ACCEPTANCE OF CITATION
The person named above acknowledges receipt of the citation issued. Any person who willfully refuses to sign
and accept a citation issued by the department is guilty of a misdemeanor of the second degree, punishable as
provided in section 775.082 or 775.083, Florida Statutes.
Signature of Recipient
Date
PART 8.
REDUCTION OR WAIVER OF FINE
The person named in this citation may request that the amount of the fine in Part 6 be reduced or waived by
demonstrating good faith in correcting the violations, or by presenting "before and after" evidence to the
County Health Department within two working days of the time of issuance of
this citation. In determining whether to reduce or waive the fine, the
County
Health Department shall consider the gravity of the violation, the person's attempts at correcting the violation,
and the person's history of previous violations. The County Health Department is not required to reduce or
waive the fine.
The amount of this citation is hereby reduced or waived to the amount of $
.
Signature, CHD Director/Administrator
Date
PART 9.
REQUEST FOR ADMINISTRATIVE HEARING
Per sections 120.569 and 120.57, Florida Statutes, the recipient has the right to request a formal or informal
administrative hearing to contest the citation within 21 days after the date the citation is received. If the
recipient fails to timely request a hearing, pay the fine within the time allowed, or fails to appear to contest the
citation after having requested a hearing, the recipient will have waived the right to contest the citation and this
citation becomes a final order requiring the recipient to pay the amount of the fine shown above.
I request an administrative hearing. Yes
No
I dispute the material facts.
Yes
No
Signature of Person Named on Citation
Date
NOTICE OF APPELLATE RIGHTS ON REVERSE
White copy: County Health Department
Yellow copy: Citation Recipient
DH 3146, 11/02 Incorporated: 64E-6.001, FAC
Page 2 of 2
Obsoletes previous editions which may not be used.
NOTICE OF APPELLATE RIGHTS
This citation becomes a Final Order of the Department if you have not contested the Citation
within twenty-one (21) days of the date upon which the Citation was served upon you. If this
Citation becomes a Final Order of the Department, you have the right to appeal the Final Order
to the District Court of Appeal in your area or the First District Court of Appeal.
YOU ARE HEREBY NOTIFIED, pursuant to sections 120.569 and 120.68, Florida Statutes,
that you may appeal the Final Order by filing one copy of a Notice of Appeal with the Agency
Clerk for the Department of Health, 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida
32399-1703, and by filing one copy of the Notice of Appeal and filing fee ($250, pursuant to
section 35.22(3), Florida Statutes) with the District Court of Appeal within thirty (30) days of
the effective date of the Final Order.
INSTRUCTIONS FOR COMPLETING DH 3146:
1. The name of the person being cited must be filled in.
Must be the owner, operator, occupant, or business
name. If a septic tank company, cite the registered contractor.
2. Below the person's name being cited, place the mailing address of that person.
May be a place of business if a
septic tank contractor, company, or employee is being cited.
3. Include the business name, if applicable. If inapplicable, put "NA".
4. Include the physical address where the alleged violation exists.
5. Indicate the date and time the citation is being issued in month/day/year format, and the time in the a.m./p.m.
format.
6. Name of inspector issuing the citation must be on form.
7. Part 1.
State the section or subsection of the law and administrative rule allegedly violated and include a brief
statement of the violation cited.
8. Part 2. Describe the observed violation and provide pertinent facts related to the violation.
9. Part 3. The county health department must complete this part.
10. Part 4.
This part is completed by the county health department employee conducting the follow-up visit or
investigation.
11. Part 5. Describe actions the property owner has already taken to correct the violations.
12. Part 6. Enter order of correction if appropriate, to include time period for correction. An order of correction and an order to pay
a fine may both be imposed. Enter the amount of the fine being imposed for the violations listed in Part 1. In no event shall the
fine imposed by a citation exceed $500 for each violation.
Each day a violation exists constitutes a separate
violation for which a citation may be issued (s. 381.0065(5), FS).
Fines shall be assessed from the date of the
initial notice of violation.
This amount may be reduced or waived as per Part 8.
Insert the name of the county
health department issuing the citation.
13. Part 7. The signature of the recipient must be the same as the person cited.
14. Part 8.
If a request for fine reduction or waiver is submitted by the person named in the citation, the County
Health Department Director or Administrator shall evaluate the justification for fine reduction or waiver and
consider the gravity of the violation, the person's attempts at correcting the violation, and the person's history
of previous violations.
If a reduction or waiver of the fine is justified, the reduced or waived fine shall be
specified in the space provided and the county health department Director/Administrator must sign and date in
the spaces provided.
15. Part 9.
The person named in the citation must indicate whether or not an administrative hearing is being
requested, and the person must sign and date the request.
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