Laserfiche WebLink
INDIAN RIVER FARMS WATER CONTROL DISTRICT <br /> 7305 4 "' Street <br /> Vero Beach, Florida ' 2968 <br /> 561 - 562-2141 <br /> 1S -131JILT CERTIFICATION OF CULVERT/STRUCTURE INSTALLATION <br /> ONE DIRECTION ONLY REQUIRED <br /> —�- —Y— f A ) <br /> _TOP OF BANK <br /> IC1 I �u ICJ CANAL SECTION <br /> CENTERLINE OF CULVERT/STRUCTURE TOp OF BANK <br /> I -= CULVERT/STRUCTURE <br /> ISI `--- ADJACENT/PARALLEL STREET OR ROAD <br /> TYPICAL PLAN VIEW <br /> Owner/Permittee Information : <br /> Name : n/� Re : Permit No . : <br /> �_ n n Y t ,�R � � Date of <br /> Address : Installation : <br /> Location : Tractc6 , Section ( Township 33 Range 3q , Canal No. <br /> Property I . D . Parcel No : Q160 [Sf- qUcn <br /> ILII in!c Beck an ro riate s aces below : <br /> (A) Distance from centerline of culvert/structure (one direction only required) to : <br /> 1 . Nearest tract or land corner ( identify):_ <br /> _ - 2 . Or,_Centerline_ofnearest public road -(identify) : <br /> � . Or, record plat corner (identify) :_ ---- <br /> (B ) Narne/number of adjacent street/road : <br /> (C) Invert of culvert/structure : East invert_ West invert <br /> (Based on 1929 N . G . V.D. ) (or) North invert <br /> South invert <br /> (D) Diameter/size of culvert/structure: <br /> (E) Length of culvert/strucblre : <br /> (F) Type of culvert/structure : R . C .P ._ , C.M. P. C .A. P . <br /> Other <br /> '--- <br /> (G ) Type of headwall : Concrete (Describe) <br /> Rip Rap C. B . S . <br /> Metal , Other <br /> No Headwall (Describe) <br /> (H) Configuration of headwall : Straight_ Wingwall <br /> Mitered Beveled <br /> Other <br /> (Describe) <br /> (1 ) If necessary, draw sketch (or further describe) any unusual detail or circumstances of this <br /> culverdstructure installation on back of this sheet. <br /> LIIJFICATION ' I hereby certify that I am a Professional Surveyor and Mapper, registered <br /> to t're State of Florida and that the As-built information shown hereon was performed under my <br /> direct supervision and is true and correct, dated this <br /> (year) . —day of <br /> ( Si ^ nod ) : <br /> (Printed ): <br /> ( Seal ) <br />