00-0115-006 Notification for Use of the Gena:al Permit for COn',ptruition of ai4 Extansion to a Public Drinking Water
- Distribution System
Project Name: N-A10 l
Permittee:
(25)lt is required that all new and-.elcrated=ritatei,serviws-bd ii, conformance with the State plumbing code, that all pipe
and pipe fittings for new and relocated water services contain no more than eight percent lead, and that all solders
and flux for new and relocated water services contain no more than 0.2 percent lead.
Signature,.Date, and Seal Name and License Number(please type or print)
1. Design/Projected Ann I Avera a and Maximum Day Water Demands for Proposed Altered/New Distribution Facilities (i.e.,
water mains�Und� his Pro'edt:
:..:::..:•::;:,_:...>:<:::.; :: :::<< Total .
:L•:
-- _� :;e:A:Numker of � PARUIatlon C . anon AY.etag�jt�ay,•::i ;Aay:..W...ater l3emand .: : Maximum
YPe :: Ugits<::•;.:>;:;: f,J1It::;.;::: (Columns 13 x C) ). O.a'>Water
P�. :Wake l3emand. ?: . :(Columns.k.
Single-Family Home
Mobile Home
A"Afflem
Commercial,Institutional,
or Industrial Facility' _
Total �
Description of Commercial,Institutional,and Industrial Facilities and Explanation of Method Used to Estimate Average Day Water Demand for These
Facilities:
r
H Explanation of Method Used to Estimate Maximum Day Water Demand., G�
2. Design/Projected Maximum Hour Water Demand for Proposed Altered/New Distribution Facilities Under this Project and
Basis of Design/Projection:
Design/Projected
Fire Demand Plus Coincident Draft(usually maximum day water demand) for Proposed Altered/New Distribution Facilities
Under this Project and Basis of Design/Projection:
3. Operating Pressure Range for Proposed Altered/New Distribution Facilities Under this Project: -*2¢- 1,Q2 re_—
4. .Will the proposed altered/new distribution facilities under this project be part of a community water system or a public water
.,ystem that has a service area also served by a reclaimed water system? If yes; document that the system has
a routine cross-connection control plan, including a written plan, in accordance with Rule 62-555.360, F.A.C.:
DEP form 62555.900(7) Page 5of 5
Effective December 10.19% .. --