PL-17-2151Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
Na PL 4- 7-21
Pluul bing:>R*sWen iia
Parcel Number
2017
fietd_.
CtVE
Expiration: 03/04/2018
Applicant
78 NE 101 Street
Miami Shores, FL
1132060131330
Block: Lot:
ROBERTO MAURICIO PALACIO
Owner Information
Address
Phone
Cell
ROBERTO MAURICIO PALACIO
78 NE 101 Street
MIAMI SHORES FL 33138-
(786)391-2280
78 NE 101 Street
MIAMI SHORES FL 33138-
Contractor(s) Phone
A TIP TOP SEPTIC TANK & PLUMBIN( (954)920-6500
Cell Phone
Valuation:
Total Sq Feet:
$ 2,400.00
200
Type of Work: INSTALL NEW DRAIN FIELD
Type of Piping:
Additional Info: INSTALL NEW DRAIN FIELD
Bond Return :
Classification: Residential
Scanning: 3
Fees Due
Bond Type - Owners Bond
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$500.00
$1.80
$2.25
$2.25
$0.60
$150.00
$9.00
$2.40
$668.30
Pay Date Pay Type
Invoice # PL -8-17-64987
09/05/2017 Check #: 1045 $ 118.30 $ 550.00
08/24/2017 Credit Card $ 50.00 $ 500.00
09/01/2017 Credit Card $ 500.00 $ 0.00
Bond #: 3503
Amt Paid Amt Due
Available Inspections:
Inspection Type:
HRS Approval
Final
Review Plumbing
1
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certifyhat all
constru,Qtio nd zoning. Futh
fore;,•'g information is accurate and that all work will be done in compliance with all applicable laws regulating
e the above-named contractor to do the work stated.
i t
u orized Signatu : wner / Applicant / Contractor / Agent
Building Department Copy
September 05, 2017
September 05, 2017
Date
1
0-0CcTP Miami Shores Village
C G 2 4 2017
.; Building Department A�
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
FBC 201 4 sth
Master Permit No. -P L �, - 215
PERMIT APPLICATION Sub Permit No.
❑ BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION El RENEWAL
4LUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: ie 4 I bt 51- frtro ,As ( 3 9
City: Miami Shores County: Miami Dade Zip: 333'
( 5
Folio/Parcel#: 11 3Ub— b (J ,1336 Is the Building Historically Designated: Yes P/ NO
Occupancy Type: Y1-7 Load:
Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Kobe, PA1Pre / a
Address: W A° 1 O \ S�
Phone#: 30-137-110
City: 1—t c ,Potyk,1
Tenant/Lessee Name:
State: 'cC_
Email: gie,4✓1 t,vcsidp ,i Al'a05Aft f 4 Z;G-LI
zip: 3(38'
Phone#: 3 z) r to7- ASzer
CONTRACTOR: Company Name: ii-repar4firirk 1,14 Pkvibto.A.(C C_' Phone#: 2 4SGd
Address: / 3,0 i J P7
3E0c-it 3(4'0
City: atOedik State: Zip: '''' j®47`f
Qualifier Name: C: /f%2bt/ ill / kid Phone#: 02b-65-06
State Certification or Registration #: 5A DOffJriv//�%' Certificate of Competency #:
DESIGNER: Architect/Engineer: "-' A'� Phone#:
Address: 1 Pr City: State: Zip:
Value of Work for this Permit: $ Z�� ' Square/Linear Footage of Work:7,t� S/1-1--
Type
2��
Type of Work: ❑ Addition ❑ Alteration
❑ Newepair/Replace ❑ Demolition
Description of Work: i...rk)51—Ll--- ..J ®r k,,-1 cup
Specify color of color thru tile:
Submittal Fee $ 50 pJ lid Permit Fee $ /Y° v CCF $ CO/CC $
Scanning Fee $ _ Radon Fee $ DBPR $ Notary $
Technology Fee $ Training/Education Fee $ Double Fee $
Structural Reviews $ Bond $ D
TOTAL FEE NOW DUE$ 1t ° �O
GIS
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of Acc-y 9 , 20 / 77- , by
/ b -4-.4f7 4-42-e, , who is personally known to
me or who has produced 1, D, as
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
APPROVED BY
(Revised02/24/2014)
EXPIRES: 2/29/2020
Bonded Thru Budget Nc r ,:sem
CONTRACTOR
The foregoing instrument was acknowledged before --me this
r day of "l"1—.1:>e" , 20 / 7" , by
G /BCW&2" /t -f. (che_(,/ , who is personally known to
me or who has produced I°P✓.lowli,i% FC .tri as
identification and who did take an oath.
NOTARY P BLIC:
Sign:
Print:
Seal:
r� J!
SSION#GG 15181
EXPIRES: 2/29/2020
Bonded Thru Budget Notary Services
**************************************************************
Plans Examiner Zoning
Structural Review Clerk
Inspector
DIVISION OF
Environmental Health
Florida Health
Miami -Dade County
OSTDS'/Well Division
11805 SW 26th Street • Miami, FL 33175
eery.
Address %.e/ A C fr ( f7
Comments:
Date
OSTDS #
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-288511
Permit Number: PL -8-17-2151
Scheduled Inspection Date: October 12, 2017
Inspector. Hernandez, Rafael
Owner: PALACIO, ROBERTO MAURICIO
Job Address: 78 NE 101 Street
Miami Shores, FL
Project <NONE>
Contractor. A TIP TOP SEPTIC TANK & PLUMBING INC
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
Parcel Number 1132060131330
Phone: (954)920-6500
Building Department Comments
INSTALL NEW DRAIN FIELD
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
Failed
Correction
Needed
Re -Inspection
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid
Inspector Comments
HRS APPROVAL ON FILE
October 11, 2017
For Inspections please call: (305)762-4949
Page 14of22
Property Search Application - Miami -Dade County
Page 1 of 1
OFFICE OF THE PROPERTY APPRAISER
Summary Report
Property Information
Folio:
11-3206-013-1330
Property Address:
78 NE 101 ST
Miami Shores, FL 33138-2319
Owner
ROBERTO MAURICIO PALACIO
GLENN E BOARDMAN
Mailing Address
78 NE 101 ST
MIAMI SHORES, FL 33138 USA
PA Primary Zone
1000 SGL FAMILY - 2101-2300 SQ
Primary Land Use
0101 RESIDENTIAL - SINGLE
FAMILY : 1 UNIT
Beds/Baths/Half
2/2/0
Floors
1
Living Units
1
Actual Area
2,277 Sq.Ft
Living Area
1,995 Sq.Ft
Adjusted Area
2,169 Sq.Ft
Lot Size
9,200 Sq.Ft
Year Built
1940
Assessment Information
Year
2017
2016
2015
Land Value
$230,092
$230,092
$175,021
Building Value
$188,703
$188,703
$126,922
XF Value
$2,172
$2,190
$2,043
Market Value
$420,967
$420,985
$303,986
Assessed Value
$420,967
$420,985
$303,986
Benefits Information
Benefit
Type
1
2017 2016 2015
Note: Not all benefits are applicable to all Taxable Values (i.e. County,
School Board, City, Regional).
Short Legal Description
MIAMI SHORES SEC 1 AMD PB 10-70
LOT 3 & W3OFT OF LOT 2
BLK 10
LOT SIZE IRREGULAR
OR 19689-1244 05 2001 5
Generated On : 8/24/2017
Taxable Value Information
Previous
Sale
Price
2017 2016
2015
County
$665,000
30554-
0289
Exemption Value
05/04/2015
$0
$0
$0
Taxable Value
$314,000
$420,967
$420,985
$303,986
School Board
19689-
1244
Sales which are disqualified as a result
of examination of the deed
Exemption Value
$0
$0
$0
Taxable Value
$420,967
$420,985
$303,986
City
Exemption Value
I
$0
$0
$0
Taxable Value
E
$420,967
$420,985
$303,986
Regional
Exemption Value
$0
$0
$0
Taxable Value
$420,9671
8420,985
$303,986
Sales Information
Previous
Sale
Price
OR Book -
PageQualification
Description
05/30/2017
$665,000
30554-
0289
Qual by exam of deed
05/04/2015
$685,000
29605
4163
Qual by exam of deed
01/23/2014
$314,000
29042-Qual
1420
by exam of deed
05/01/2001
$0
19689-
1244
Sales which are disqualified as a result
of examination of the deed
The Office of the Property Appraiser is continually editing and updating the tax roll. This website may not reflect the most current information on record. The Property Appraiser
and Miami -Dade County assumes no liability, see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp
Version:
http://www.miamidade.gov/propertysearch/
8/24/2017
REGISTERED SEPTIC TAM( CONTRACTOR
CLARENCE MITCHELL
PO BOX 1142
DANIA, FL 33004-
A TIP TOP SEPTIC TANK AND
PLUMBING, INC
Business Authorization: SA0091619
SR0890607
Registration Expires on September 30. 2017
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2016 THROUGH SEPTEMBER 30, 2017
Receipt //: 9 OTHER TYPES CONTRACTOR
Business Type' (SEPTIC TANK CONTRACTOR)
Business Opened:05/26/2000�
State/County1Gert/Reg:SR0 8 9 0 6 0 7
Exemition Code:
DBA;
Business Name: A TIP TOP SEPTIC TANK & PLUMBING
Owner Name: CLARENCE MITCHELL
Business Location: 22 NW 14 AVE
DANIA BEACH
Business Phone: 954-920-6500
;Rooms
Seats
Employees
3
Machines Professionals
For Vending Business Only
Number of Machines:
Vendlnq TYpe:
Tax Amount
Transfer Fee
NSF Fee
Penalty Prior YearsCollection Cost
Total Paid 0
29.70
27.00
0.00
0.00
2.70 I 0.000.00
THIS -RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved Me
business location This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
CLARENCE MITCHELL
P 0 BOX 1142
DANIA BEACH, FL
33004-1142
Receipt #04B-16-00000215
Paid 10/18/2016 29.70
2016 - 2017
wamoimivmstittnvowsroaeraikvoutoorvir
CLARENC E MITCIIELL
A TIP TOIj SEPTIC TANK AND PLUMBING, I
PO BOX 1142
DANIA, FL 33004 -
HEALTH
FLORIDA DEPARTMENT OF HEALTH
CERTIFICATE OF AUTHORIZATION FOR SEPTIC TANK CONTRACTING
The Florida Departn ent of Health hereby certifies the business or entity named below has satisfied the requirements of Part
III, Chapter 489, Florida Statutes, for septic tank contracting and has been duly authorized by the Department to provide
septic tank contracting services under the name o, f
A TIP TOP SEPTIC TANK AND PLUMBING, INC
Qualifying Contractor: CLARENCE MITCHELL
SA009161? February 28, 2017 March 31, 2019
Authorization Nufnber Date Issued Expiration Date
100%
AIWATER
FINANCIAL OFFICER
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DMSION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW
CON TRUCTION INDUSTRY EXEMPTION
This certifies that the Individual fisted below has elected to be exempt from Florida Workers' Compensation Law.
EFFECTIVE DATE: 8115/20' 16 EXPIRATION DATE: 8/15/2018
PERSON: MITCHELL YASMA
FEU,I: 651010141
BUIINESS NAME AND ADDRESS:
A Tip TOP SEPTIC TANK & PLUMBING INC
1351 W DANIA BCH BUND
DANA FL 33004
SC OF BUSINESS OR TRADE:
PLU BING NOC AND IRRIGATION OR
DRI ERS DRAINAGE SYSTEM
toChapter 448.05r14). F.&, an °Meer at a corporation who elects wom n Gum this dheriq a ateteaba umlaut=sect=
tacarer bei or compensation tenter N s cRapter. Pursuant to Cha 44&83(121 F.S. Cel of election to be exempt.. apply only
within scope of the business or trade Bated on theeleetlon to bechapter 448.85(131 F.S., =noes at election to be
btuexempt
bt=anon to be slain be subject to rayl it. al any time aft:
of the notice or =Issuance ante fps.
Me • • muted on Me nobs or cedlicata no Ginger meets the requirements art= sermon for lemma ota bertittato. The department shall revoirea
DFS--DWC-252CERTIFICATE QFELECTION TOBEEXEMPT REVISEDOB-13 QUESTIONS'? (850)413-16M
100%
JEFF ATWATER
CHILF FINANCIAL OFFICER
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL. SERVICES
OMSION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
RIVE DATE 6117/2018 EXPIRATION DATE 6)17/2018
: MITCHELL CORTEZ
FEI : 651010141
BU (NESS NAME AND ADDRESS:
A TI TOP SEPTIC TANK & PLUMBING INC
1351 W DANIA BCH BLIVD
DAN FL 33004
SC • S OF BUSINESS OR TRADE
PLU :ING NOC AND !IRRIGATION OR
DRAINAGE SYSTEM
D
toauger 44o.o5(14),F.8. an of9Cer of a carpanwho dem exempts Non this chapter by a at election oder this section
efAVE
benefits oro t under dds doper Pasard m ampler 44405(12). F.S..rkrtdca�et elec ontobe exempt_
of electlontoo be a ndal bre ne!newel tore igym .Plasmal to 440A5(1 F.3.. Noirma tort io be
named on the nottee Dr tubecertificate ange bee ;raced mrevom�n a,eta��on f r WBre a&m[ffianrad9re mrd.
meets the olUdasedimrfor bmamtemacent/We Ttmdepmbredshag wake a
-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED O8-13
QUESTIONS? (850)413-h6Uo
100%
JEFF AIWA1ER
CHIEF FINANCIAL OFFICER
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE 7116/2018
PERSIA: MITCHELL
FEIN: 651010141
BUSINESS NAME AND ADDRESS:
A TIP TOP SEPTIC TANK & PLUMBING, INC
EXPIRATION DATE: 7/16/2018
CLARENCE
1351 $i DANIA BCH BLIVD
DANIAf FL 33004
SCOPES OF BUSINESS OR TRADE
PL ING NOC AND
DRI S
IRRIGATION OR
DRAINAGE SYSTEM
Pursuant Cheeks 440.0504 F.S.. an oilier of a =manna Irmo elects exemption torn ma chapter by flingamin t°ot elecerm wider Bgs section
may not benskts w omnpereaan under egs., r Pwm to Meister 440115(1), F.&, c or election to be ez rceext 6y
wfhm 00 of do hwauoss of beds 0ffiedon Poe sl eek Uo be a mpt. Pwsvmd 60 440.03(13), Tale
s sal th he
cmed o es ctete rto be exempt eh� to ere to reu I et any time to r sw o1 9w n� m me ldepartment
epartm n them,
Ms named on the noticeWmr6flmto nob mete requirements al Ns section tar ofecertNCate. The Qepa511 ,1l®p rarobea
DFS- F2-bWC -252 CERTIFICATE OF ELECTION TORE EXEMPT REVISED 08-13 QUESTIONS? (860)413-1609
AUG 2 4 2017
LEGAL DESCRIPTION:
LOT 3 & THE WEST 30' OF LOT 2 OF "MIAMI SHORES SEC
ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT
PAGE 70, OF THE PUBLIC RECORDS OF MIAMI-DADE COUNTY, FLORIDA.
wag' NW 101ST STREET
19.5' ASPHALT ROAD
75' R/W
X0.69
22.2' PARKWAY
80.00'
5' SIDEWALK
FJ.R. 1/2' '
No I.D.161
C.B.S.
WALL
0.04'CL
10.39'
2
fm.
124,
11.5'
0.38'
10.0/
-11
31.3'
ONE-STORY C.B.S.
mri9ation RESIDENCE: 78
well GARAGE EL=10.23'
F.F.EL=12.14
21.1'
13.6'
10.24•
Lor 4
BLOCK 10
IOC
9°>
E1.R.1/21p.0
No 1.0
06,
CONCRETE
LOTS .
BLOCK 10. " '10.36
Crl
14.9
1.2'
21.7'
CLEANOUT
° WEST 30' '
LOT 2
\ N
0, •
04
Jo.•.
F.I.R. 1/2'
No I.D.
C.B.S.
WALL
0.07'CL
/✓'
—11.97'-
11
10.2
-075.34'
10
4' CHAINLINK!FENCE
80.00'
X50
e��
W.F
01
O
i
REMAINDER
LOT 2
BLOCK 10
NOT INCLUDED
a.rC't''W.F
o I.D. �6.
10-34' 4
15'ALLEY
10' ASPHALT
10.56'
RNEST W. DUNCAN P.S.M. 5182
521 SE 5TH COURT
POMPANO BEACH, FL. 33060
JOB NO.
07-92-17
PROPERTY A
BOUNDARY SURVEY
DDRESS:
PHONE. (754) 264-2166
FAX (954) 827-0535
78 NE 101 STREET
MIAMI SHORES, FL 33138
Scale: 1" = 20'
F.I.R. DENOTES FOUND IRON ROD
NO ID. DENOTES NO IDENTIFCATION
M.E. DENOTES MAINTENANCE EASEMENT
D.E. DENOTES DRAINAGE EASEMENT
CONC. DENOTES CONCRETE
R DENOTES RADIUS
D DENOTES DELTA ANGLE
L DENOTES ARC LENGTH
U.E. DENOTES UTILITY EASEMENT
D.H. DENOTES DRILL HOLE
R/W DENOTES RIGHT OF WAY
P.R.C. DENOTES POINT OF REVERSE CURVE
LS DENOTES LICENSED LAND SURVEYOR
P.S.M. DENOTES PROFESSIONAL LAND SURVEYOR
N/A DENOTES NOT APPLICABLE
A/C DENOTES AIR CONDITIONER
NAVD88 DENOTES NORTH AMERICAN VERTICAL
DATUM OF 1988
NGVD29 DENOTES NATIONAL GEODETIC VERITCAL
DATUM OF 1929
1`1- Zls 1
-, 1?T
FLOOD ZONE:: X ._.
BASE 11000 ELEV.= N/A
FEMA MAP / 12086C 0302 L
DATE OF FIRM: 09/11/2009
0447
SYMBOL
® WATER METER
o UTILITY POLE
x -- CHAIN LINK FENCE (C.L.F)
WOOD FENCE (W.F)
EXISTING ELEVATION
0 10 20
1 inch = 20 ft.
40
SURVEYORS NOTES.
1. ANGLES SHOWN HEREON ARE REFERENCED TO THE RECORD PLAT
AND ARE AS MEASURED.
2. BENCHMARK REFERENCE: DADE COUNTY BEIVBIAMIRK "N-567"
ELEVATION=10.54 NGV149• •`
ELEVATIONS REF£RENCEE TO 4'GW29. • • • •
•• • •• •
3. MINIMUM LINEAR ACCUggAr T.4/NED: • • • • • •
1 FOOT IN Z500 FEET AS REQUIRED FOR •
A SUBURBAN SURVEY
4. NO TTTLE INFORMA I1OAi bS S7JQPLIED 0/ AES4Eh
IN THE PREPARATION Of 1?AS5URVEY MIN THC •
EXCEPTION OF THE LEGV..D'SCFIPTION. • • • •
5 NO ATTEMPT WAS MADL•TO•LOCAIE ANN,ENDEFGROUND
IMPROVEMENTS, OVERHE,4D•14T14I'ES, (POWERLOI£S, ETC)
FOUNDATIONS OR WETTNDS! •
• • •
6. EASEMENTS SHOWN HiREON ARE PER TI "Ftre •
7 SURVEYOR HAS MADE 117•RESEiIRCH OFNNE• PUBLIC •
RECORDS. THERE MAY BE ADDITIONAL RESTRIC11(
NOT SHOWN HEREON THAT MAY BE FOUND IN THE
PUBLIC RECORDS.
•
•
•
• •
•
•
•
••••••
•�
•
•
CERTIFIED TO:
GLENN BOARDMAN & ROBERTO PALACIO
DATE OF SURVEY 7/29/17
ERNEST W. DUNCAN, P.S.M. STATE OF FLORIDA
PROFESSIONAL SURVEYOR AND MAPPER No. LS 5182
NOT VALID WITHOUT THE SIGNATURE AND
THE ORIGINAL RAISED SEAL OF A FLORIDA
LICENSED SURVEYOR AND MAPPER.
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number
PART II • SITEPLAN
Scale: Each blocs represents 10 feet and 1 inch = 40 feet.
u SIT
E Cj
Notes:
,n
4.3
c
4
.L'
V
There are no pertinent features.on adjacent properties
And or across the street that may affect the new system installation
I
Site Plan submitted b
Plan ApprovedDv
•
j� . • 1
k •
•
•
Not Approved 111
• •
•• • • • ••
Cate
County Health Department
•• • • • ' • •
• . •••• • •• •• •• ••
ALL.• CHANGES MUST BE APPROVED SUTHrCOUNNY MAL` N DE?'PARTMENT
01-14015, 08109 (Obsoletes previous editions which may not be used) incorporated: 64E-6.001, FAC Page 2 of 4
••• • • • • ••• • •
(Steck Number: 5144-002-4015-6) • • • • • • • •
• • • ••• • • •
• • • •• • • • • • • •
• •• • • • •• ••
••• • • • ••• • ••
0
O
6