HomeMy WebLinkAbout1992 Boone Street Permit Application r
PERMIT HO . 42-061-0363NG
AS - R111 I,T CERTIFICATION BY PROFESS I OMALi ENGINEER
( Permit Application ) I
Within 30 days after completion of construction of the stormwater
discharge facility, submit: this form to the St . Johns River- Water
Management: District , Division of Records , P . n. I3ox 142.9 , Palatka,
Florida 32011 - 1429 .
I . Stormwater Discharge Facility Information :
Sour rce "nine ! S.00neSt , Parking Lot
Scarce Location : Street Corner of Indian. River_ Dr_.&_-Main- St. _
Cil;y Sebastian County Indian River
7 . As f l i t i t t- C e r t i f i c a t i o n :
t herehy certify that this stormwat-er discharge facility has been
brr i 1 1; subs t:ant i a l 1 y in accordance with the approved plans and
specifications and that any substantial deviations ( noted below )
wi l 1 not prevent the system from functioning in compliance with
the rerluir. ements of Chapter 40C - 42 , F' . A . C . , when properly
maintained and operated . These deter.m i nat ions have been based
upon on - site observation of construction scheduled and conducted
by me or by a project representative under my direct supervision .
I -have enclosed one set of as--built engineering drawings .
(ry ,A4,7_
/. - 1is,t.= - `/9� _ Daniel__Cs_Eckis ----------------.----- .-
. rgnature of Engineer Name ( Please Type )
33643 City of Sebastian, Fl
Florida Reg . Number Company Name
1225 Main St .
Company Address
ress
Sebastian, Fl 32958
1q tQ : 94-27-92 Telephone No . j4071 589-5490
Subs tant: is l deviations from the approved plans and specifications
( attach additional sheets if required ) .
Minor, relocated North entrance drive per IRC Drive way permit ,
as built plan indicate final grades and elevations .
01v oa, City of Jebastlan
. , 4' Q mil) POST OFFICE BOX 780127
%',11 U r1 SEBASTIAN, FLORIDA 32978 LETTER OF TRANSMITTAL
It TELEPHONE (407) 589-5330
T1 FAX (407) 589-5570
T0: QM i�� / , Date: 1f . 2"--_ Attendgq -__
Re: f 1st'.-,LZ 11T �� -'2s1F-_L2-1
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___ Under Separate Cover Via The following items:
WE ARE SENDING YOU: Attached ____ ,
___ Shop Drawingsrints Plans Specifications Copy of Letter ___ Change Order.
COPIES DATE NO. DESCRIPTION
THESE ARE TRANSMITTED AS CHECKED BELOW:
— For approval — Approved as submitted _ Resubmit _ copies for approval
For your use — Approved as noted __ Submit _ copies for distribution
As requested — Returned for corrections — Return _ corrected prints
For review and comment
For bids due 19
COPIES TO: REMARKS
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Signature