2000 DRAINFIELD o
a y LORIDA DEPARTMENT OF HEALTH
LTH
E-D,
z (305) 623-35
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� STATE OF FLORIDA PERILIT NO.
. o%an?l
DEPARTMENT OF HEALTH DATE PAID: - -L–Vv
ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM FEE PAID: 7 w
.�
CONSTRUCTION INSPECTION AND FINAL APPROVAL RECEIPT #:
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APPLICANT: to—lei G h
AGENT: s EVR L Co1411 C<q(0s 1 N L
PROPERTY ADDRESS s G 1y 3ST. 1V1 t o-rte t' f 1=1 3 3 13�
LOT: BLOCK: SUBDIVISION: iQQ ce'SZ t nC t V*A Wk`.]g h PROPERTY ID #: /1-2232-63/,g 66
CHECKED [X] ITEMS ARE NOT IN t.OMPLIANCB WITS STATUTE Olt RULE AND MUST BE CORRECTED.
TANK INST]LIZA 'ION ACKS
I ] [01] TANK SIZE 11I.W 121 [ ] 127] SURFACE WATER FT
[ ] [02] TANK MATERIAL [28] DITCHES FT
t ] [03] OUTLET DEVICES [ ] 129] PRIVATE WELLS ! FT
[ ] [04] MULTI—C= 130] PUBLIC WELLS FT
I ] 105] OUTLET FILTER ] 131] IRRIGATION WELKA FT
I l 106] LEGEND 1 ] 1321 POTABLE WATER LINES FT
I ] [07] WATERTIU I ] [33] BUILDING FOUNDATION FT
[ ] [08] LEVEL 'U I ] [34] PROPERTY LINES > FT
[ ] [09] DEPTH TO LID I ] 135] OTHER FT
DRAINFIELD INSTALLATION
I[ ]] INS IONFILLED / MOUKD SYSTEM
[10] AREA [ g� [2a84FT [36] DRAINFIELCOVER
[11] DISTRI8ION IrY`
z �� [ ] [371 SSOVLDERS
[ l [12] NUMBER OF DRAINLINES I ] 138] SLOPES '
[ ] [13] DRAXNLXNE SEPARATION,— 1 ] 139] STABILIZATICK
I ]
11-61 DRAINLINS SLOPE 1���� << ! IUP
[ ] [151 DEPTH OF COVER 2/ '( ADDITIONAL INFORMATION
[ ] [16] ELEVATION [ABOVE/BZLON] [ ] 1401 nmO88TRIICTED AREA ��(J
1 l 1171 SYSTEM LOCATION y [ ] 1411 sTo AREA
I ] [18] DOSING PUMPS ] 1421 ALARMS
I l 1191 AGGREGATE SI I l 143] fiCE
[ l [20] AGGREGATE EXCESS FINES I ] [44] BUILDING AREA
1 ] 1211 AGGREGATE DEPTH/.�,- 1 ] 145] LOCATION CONFO �VweI SITE PLAN
[46] FINAL SITE
FILL / EXCAVATION MATERIAL [ ]
[ ] CONTRACTOR
[22] FILL AMOUNT rJfT 1481 OTHER ��1c=4o�✓
[ ) [23] FILL TEXTURE
t ] [24] EXCAVATION DEPTH yy O ABANDONMENT
/
1 1 1251 AREA REPLACS�Y X/1 -al-yw 1 ] 1491 TANK PUMPED'�/ 1>3_/_
I ] 126] REPLACEMENT MATERIAL Q/r 1 ] 150] TAN[ CRUSSBD i FILLED
EXPLANATION OF VIOLATIONS / REMARKS:
[ l
[ l
[ l
CONSTRIICTI [APPROVED/ ISAPPROVEDj: CSD DATE:j '
FINAL SYS [APPRO /DISAPPROVED]s CSD DATE: ,O
DH 4016, 10/97 (Previous Editions May Be Used) Page 2 of 3
Applicant a-
1
r PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
(0 - z23z- 0 6'0
Date 2� - Address �„� �� 6 V� '�� � Tax Folio 1 0
Legal Desawm Ui 2- buc SC,f-N 15C '(S4soorically Desigoa & Yes No
Oaoedi essee/Ten ew Master Permit#
ownees Address I.�g' �C X03 S'T Pie"�13�'12Sq
—Co._< �G C.0N C, Address W960 0 WW.,2 A, *ZZ3 PIM-M)
Qaal Tma s)r�' ISS# M Phone c? 6 633
State# 18' Mt>r icw# Competency# --- Ins.Co. Nd9�Tt Lk S'
I
Architied/Eng�oer Address
BonftCompW A&1=
Mortgagor Address
Penu t Type(circle one): BUMDION,G� ItELECTRICAL Um MECHANI
CAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTIONC'k
i
Squ=
I
Ft. OCD8 Intimated Cost(value) 1T WARNING TO OWNER: YOU MUST REC RDA NOTICE OF CO CEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR SIPROVEMENTS YOU
PROPERTY(IF Y II RMM TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORD G YOUR NOTICE OF CO CEMENT.)
Application is hereby made to Main a permit to dp work and installation as indicated above,and on the attached addendum(if applicable). I certify that all work
will be pu mmed to meet the ids of all lauva regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING,SIGNS,POOLS,ROOFING and MECHANICAL WORK
OWNERS AFFIDAVIT:-I ce r*that all the f0egoing information is accurate and that all work will be done in compliance with all applicable laws regulating
conshvction aml zoaring Furthermore,I autbokke the above-named contractor to do the work stated.
S' owner and/or Cando President Data S Contractor ar Builder Date
CO 173 J- _d-)-7 -
as Ower and/ Date
My t
NA
N as to
r s
Date
My jQgRbYpiW-n O RcMAROAFnTA MONnEL
COMMOswa NUAIM
CC797277
ODMM e � COMMON oM
Wes. crreDEC.EXa0
FUL
FEES: PE
RADON_ C.C.F. NOTARY BOND ,345®
APPROVED: �� TOTAL DUE-2� .44d
Zoning Building i Electrical
I
Mechanical Plumbing ftucturdEngineer
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STATE.OF FLORIDA PERMIT loop 14 ,
1
DEPARTMENT OI 'HEALTH DATE PAID
•. a�. _,.P�n
ONSITE SEWAGF� DISPOSAL SYSTEb! F$E PAID $ "9
+.�
CONSTRUCTION,PERMIT RECEIPT'
1we `* Authority's chapter 3$1, FS & apter, lbD-6, FAC
CONSTRUCTION PERMIT FORS
Lw New System ` [ 4] Ex4st�ng System [ .�j H 1;ling'. T�ilk . [' �Ij ,Temporary/Experimental
[ ] Repair ,Aband nment [ j Other(Spbi:440
APPLICANT'! AGENT S
.� 1
PROPERTY STREET ADDRESS:'
LOT: 'BLOCK: SUBDIVISION:
PROPERTY ID #*. [S CTION/TOWNSHIP/RANGE/PARCEL .NUMBERj
Ge fa 101 TAX r:ID>NUMBER]
•I
SYSTEM MUST BE CONSTRUCTED ' IN ACCORDANCE .WITH SPECIFICATIONSAND STANDARDS OF CHAPTER IOD-,6,
FAC. REPAIR PERMITS AND HOLDING TANK PERMITS PIR*-'90 DAYS FROM THE DATE OF ISSUE. ALL OTHER
PERMITS EXPIRE ONE YEAR FROM THE DATE OF .ISSUE. DEPARTMENT .OF HEALTH APPROVAL: OF SYSTEM DOES
NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY PECIFIC PERIOD .OF TIME. : ANY CHANGE INMATERIAL
' FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF rHIS 'PERMIT. REQUIRE THE APPLICANT TO MODIFY THE
,. .PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID..
SYSTEM DESIGN AND SPECIFICATIONS
T [ q00 ] [G / GPD j, AEROBIC UNIT CAPACITY ' MULTI-CHAMBERED/IN SERIES 3 [ ]
A [ } [G / OPD] CAPACITY MULTI—CHAMBERED/IN SERIESs'[ ]
N [ ] GALLONS. GREASEIINTERCEPTOR CAPACITY [MAXIMUM 'CAPACITY SINGLE TANK: .1,250 GALLONS]
K [ ] GALLONS PER DOSP DOSING TANK' CAPA ITY DOSE -RATE { ] PER 2'4 HRS NO. ,OF ,PUMPS: [
RX DRAINFI
D [ '" ] ;SQUARE FEET PRIMA ELn SYST
R [ �. .']. SQUARE FEET SYS
A TYPE SYSTEM: STANDARD [ ]: PILLED [ ] MdUND
,.' '
I CONFIGURAThON• [: .
),' TRENCH,
[�( ] ED ].
5 • , N
. 10 LOCATION OF BENCHMARKa /moi-+ 'M' M • �- / J
I ELEVATION OF PROPOSED .SYSTEM SITE [�Co®] j [ABOVE BENCHMARK P'ERENCti"°'P�fIwr
E BOTTOM bP' DRAfNFIELD TO BE [ 31 t&o ] [ ] lA.BOVE;;9R BEN
-L
D FILL •REQUIRED: [ yf ] -INCHES EXCAVATION' REQUIRED: [ �� j ;INCHES
O
jr OF LOAMY COAD�"6AR9®
T UNDER'BOTS 0M OF DRAT�iFIELD
H SUBMIT GENCHMAKK uh�_UHt INSPECTION.
rmn UF
R e
SPECIFICATIONS BY: 1lCTITLE! Q
APPROVED BY s I TITLE r10AW
- "' A
DA'Z'E, ISSUED's` EXPIRATION DATE! C
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DH 4018.10 HR8-H'Fwm 4018[Page 1)%yhlch mey be uded) Page l of ,2
{8tock Number. 5[44-�1-4018-0)
App]icant
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rINSTRwCTIONS:."
PERMIT NUMB=t-' _.. Per B fijJmmber by County Health Departm &IZ .
x � _
APPLiCATIONFM Check ape 0001t;if zo&r"�spc*typi,L blOtt
iA a
s TBLOSONE: Telephone ermber for applicant Of 4008L '
�T
� A Ptoparty cwrDer's leislly a»thoriaad�representstNe _. -. . 1
.w
:.j 7��.'.Al
t
' iz MAILING ADDRESS: P. •�
O.box or street maillnS address for appl �r a
•
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F'.:aOT,BLOCK, or
PROPERTY IDN: 27 character
aai�rr
I�ICMM ��
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TANK: Mi>�ilDuaeSestioadt tlDt+drAC.. ,''r. r•_: .r _ �` `f
�i�aD: Minimum tpercifiaations& Cimp IOD-S FAC.
` Ra :mvari
iI ECIFICA�TtOW BY: Naa+e Qt3D��Wmrt + dlq lous.�'iF b E+ $' aupt!ite se} d• y _
APPROVED BY: County Health Departm o pmennel.nvkw+iaS+Ind approur
DATE IS D:._ 4t' _ is TP a. t
lFomdat0 ItILIF btR,#Qt
bee*. ' Pgmkt sywa rc*ra
tip become,void+NO days fnrne'de
8�4 �'1ATir: � One>t�` � � ,:. • �
date Issued: ,.u__: . `_,. _v" _ `� � _ ,' }•
,
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STATE OF FLORIDA PERMIT
DEPARTMENT OF BEAU$ DATE PAID
ONSITE SEWAG* DISPOSAL SYSTEM FEE PAIb' ,, i
APPLICATION FOR CONSTRUCTION PERMIT RECEIPT
at "ty Authoritys chapter 381, FS & Chapter 1OD-6, FAC
`, , APPLICATION FORS `
[ ],New System [ ] Hzist#g System [ j Nolding Tank [ ] Temporary/Experimental
Repair [ ] Abandonment { ] Other(Specify) �-
APPLICANTS K TELEPNQNEwS��/IG+r 6p.
AGENT:vjl
MAILING,ADDRES4 s 1 g o `
BE COMPLETED St APPLICANT {OR APPLICANT'S A ORIZED AGENT,, 7 ,ATTACH BUILUINGF PLAN AND TO-SCALE
SITE PLAN" BHOWING4 PERTINENT 1?EATURES REQIIIRED B CNAPTE$ lOD-6, FLORIDA ADMINISTRATIVE CODE.
aaa�aaa=m�e�=axa sm�maazass
`PROPERTY INFORMATION [IF LOT IS NOT IN A RECORD SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
IATs t SUBDIVISIONS v"' . ? �DATE or
SUBDISIONs .
'
PROPERTY ID ,]Es 1���, Z•� ,..-Q® 66 Sec ]on/ ownship/Range/Parcel Ito.]
` PR pERTY SI'S i ACRES [Sgft/43560] PROPERTY WATER SUPPLYs [ ] PRIVATE [ J PUMAC
. :;PROPERTY STREET ADDRESSs �_ n
DIRECTIONS TOPROPERTY: ITO
^
...
FM kA
a
1.+( "L)
ib tvr
BVUIDINI ;,iNF0104ATION I)Q RESIDENTIAL [ j COMMERCIAL
Unit. T60 of No. of Building Persons Bus inbss Aotivf��y
NO Establishment �J "Bedrooms "ria Saft Served For ,Cbmntercial Only -
f;"' 3
8
o` f^ r`
] ] 'darbage, rars/Digposels [. ] Spas/Not Tombs [ ] vloor/aipmenk Drains
[ ] Ultra-lob i ]Lume Flush Toilets [ ] ,Other..(Specify)
APPLICANT„s .SL . r DAT
DH 4015,10/86(Replaces HRS-H Form 4015[Page 11 which may b§w r Page 1 of 3
(Stock Number. 5144.001-4015-1) l
I
Y ....a. ,.• ar 1^•. mt, ,,..�u ,.7 F A:-:it.\..wl xv.,i�t ,vYn„'.: �sa...v -,:.; ,4w. -4,,,.'. 1.wa.:.i_„ ...,,a,._ -nYh.,+.v..,k.c._1 . .Lna.._�J.u.I�rA.'v„if^a araW+fL.Lu.uvk.,U...n.1.�^!sitw'?+S?r'k..y'..�a.ri.^e..ue,-.a...1,....ottt7r<�:S_teY,.a.. ..rtw�..
INSTRUCTIONS:
APPLICATION FOR: Check type of permit,if'Other'specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O.box or meet,city,state and zip code mailing address for applicant or agent.
IAT,BLOCK, Lot,block,and subdivision for lot(recorded or unrecorded subdivision). If kit is not in a recorded subdivision,a copy of the lot
SUBDIVISION: legal description or deed must be attached.
DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books(month/day/year)or date lot originally recorded. Dividing an approved
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot.
PROPERTY IDg: 27 character number for property. (Health Department may require property appraiser IDM or section/township/range/parcel number.)
PROPERTY SIZE: Net usable area of property in acres(square footage divided by 43,560 square feet)exclusive of all paved areas and prepared road
beds within public rights-of way of easements and exclusive of streams,lakes,normally wet drainage ditches,marshes,or other
such bodies of water. Contiguous unpaved and noreomgnacted rod rights-of--way said easements with no subsurface obstructions
may be included in calculating lot area.
WATER SUPPLY: Check private or public.
PROPERTY-ADDRESS: Street address for property. For lots without an assigned street address,indicate street or road and locale in county.
DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location.
BUILDING INFORMATION: Check residential or commercial.
TYPE ESTABLISHMENT: List type of establishment from Table 11,Chapter IOD-6,FAC. Examples: single family,single wide mobile home,restaurant,
doctor's office.
NO.BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for
occupants.
BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit,excluding garage,carport,exterior storage riled,or open or fully
screened patios or decks. Based on outside measurements for each army of structure.
g PERSONS: Number of persons residing,using,or working in establishment. For residential establishment,2 persons per bedroom are
assumed. c
BUSINESS ACTIVITY: For commercial applications only. List number of employees,shifts,and haus of operation,or other information required by
Table D,Chapter IOD-6,FAC.
FDCTURES: Mark each listed fixture with number installed or'NA'if not applicable.
SIGNATURE: Signature of applicant or agent. Date application on day submitted to Health Department with appropriate fees and attachments.
ATTACHMENTS: A site plan drawn to reale,showing boundaries with dimensions,hwationt of residences or buildings,swimming pools,recorded
easements,onsite sewage disposal system components and location,slope of property,any existing or primed wells.drainage
features,filled areas,obstructed areas,and surface water. Location of wells,onsite sewage disposal systems,surface waters,and
other pertinent facilities or features on adjacent property,if the features are with 75 feet of the appleant lot. Location of any
public well within 200 feet of lot.
For residences,a floor plan(residences)showing number of bedrooms and building area of each unit. For nonresidential
establishments,a floor plan showing the square footage of the establishment,all plumbing drains and fixture types,and other
features necessary to determine composition and quantity of wastewater.
-, ..ws :�s.�:.�s•�ei�.,- r,�+a _a. ��.---.. ..;, ,.,. :::: vim-. u
STATE OF FLOR DA° PERMIT i
DEPARTMENT'OF'gEALTH
ONSITE SEWAGZ,�DISPdSAL SYSTEM
SITE EVALUATION AND SYSTEM .kPECI ICATIONSwit '
�I
APPLICANT AGENT s G `�✓�+ V,�1�1
1� 7
LOT't sBLOm 2 SUBDIVISIONSEk,
PD11 a � /Range/Parcel No. or Ta: ID Number]ROPion/
'
aa�aaas
BE COMPLETED SY ENGINEER, #ALlfUNI!k- EMPLOY",,._OR OTHER QUALIFIED PERSON. ENGINEER S MOST
PROVIDE,REGISTRATION NUMBER AiD,.$IGN :AND ,SRAL`xkw PAGE OF SUBMITTAL• .COMPLET$ ALL ITEMS.
jQFT
PROPERTY. SIZE CONFORMs:TOSITE PLANS [ ] YS NO NET USABLE AREA AVAILABLEt aACRES`, •.TOTAL.LSTII�TLD SEWAaF, FZOWY, °�C�. ALLO PER DAY [RESIDENCES-TABLE.I / OTHER-TABLE 2]AUTHORISED SEWAGE FLOW! ALLONPER DAY` -[1500 GPA/ACRE OR '2500 GPD ACRE] A
AREA AVAILABLE s _ UNOBSTUC'$A'D AREA 1tEQIIIRED t d I gQFT j
BENCHMARK/REFERENCE POINT ; _OCATIONS ,
' ELEVATIQN OF, PROPOSED SYSTEM SITE,IS [IN HES [ABO ] BENGHMARRf CE POINT
THE MINIMUM 8 WHICH CAN' SE MAINTAINED, FROM THE PROPOSED SYSTEM TO "THHE FOLLOWING,FEATURESS f
SURFACE WATERPSO FT DITCHES/SWALE a FT. GRMALLY WET7 [ ] YES [ ] NO
WELLS= PUBLICS PT UNITED USES PRIVATES FT NON-POTABLES FT
BVIX+I�.INQ FOUNDATIONS s. FT -PROPERTY LI $t FT' POTABLE.WA I �.INE3 s 'T
STYE SUBJECT, TO FREQUENT PLOOOINGs, [ ] YES j O 10 YEAR 3+LOODIN I I YES [ NO
YEAR FLOOD ELEVATION PO S�s FT �`SL/NGVD . SITE ELEVATION: _ FT.MSL/NGVD
�' '
ItO2L. PROFILE INFORMATION SITE 1 SOIL .FROFILE INPORMA'1`%" OTTE 2
ss oar Texture--:- sell o ex urs ) h
o
Ve ell #/ t'i tio �il
t0
to
to . Low
tc � s
t �'_
USDA SOIL SERIESt IISDA' SOIL S�ERIESs ' _
j
�IBSERVED WATER,TABLEt, _N�INCHES 1"0"' / BELOW,] EXISTING GRADE. TYPES F'ERGHED /APPARENT]
PST MATED WET SEASON WATER'TALE ELEVATIfl t INCHES [ ABOVE ] •S%IS YNd GRADE.
HIGH'.WATER TABLE VEGETATIONS [ ] YES ;.[ 1�T0. MOTTLING: [ ] YES [ NO EP'�'Hs INCHES
SOIh TEXTURE/LOADING RATE,FOA,SYSTEM•SIZING; DEPTH' OP ;E%CAVATIONs INCHES
;.
�' DRAINF ZLLD.C01dF'I43URATIQNt [ j ] TRENCH ' I, ]. BED I ] OTHER: (SPECIFY) y
REMARKS/ADIIITIONAL CRITERIA: `
r
SITE EttLvATED B : DA
Page 3 of 3
DH 4018,I(M(Repiaoes HRS4j Fam►4015(Page 31�hieh"yy be u$ed)
1 ;
(8tadc Number: 57444034015.1) `
INSTRUCTIONS: '
PERMIT NUMBER: • Permit tracking number by County Health Department.
APPLICANT: Property owner's full name:
AGENT: Property owner's legally authorized representative.
LOT,BLOCK,SUBDIVISION: Lot,block,and subdivision for lot.
PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section/township/range/parcel number).
PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available-lot area,exciusive of _
all paved areas and prepared road beds within'public rights-of-way or easements and exclusive of streams,Iakes,
normally wet drainage ditches,marshes,or other such bodies of water.
SEWAGE FLOW: Record the estimated sewage flow for the establishment from Table I (residence)or Table 2(non-residential),
Chapter IOD-6,FAC. Record the authorized sewage flow for the lot based on net usable area and water supply
(1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If
authorized sewage flow.does not equal or exceed the estimated sewage flow,the application must be denied.
UNOBSTRUCTED AREA: Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at
least 2 times as large as the drainfield'absorption area and at least 75 percent of the unobstructed area must meet
minimum setbacks in Chapter IOD-6,FAC. The unobstructed area must be contiguous to the drainfield.
BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the
elevation of the proposed system site in relation(above or below)to the benchmark.
MINIMUM SETBACKS: Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or
"NA"for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured.
The location of any public drinking well within 200 feet of the applicant's lot must also be verified.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for
site and actual site elevation.
SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil
identification will use USDA Soil Classification methodology(Munsell colors and USDA soil textures). Refusals
must be clearly documented. Provide USDA soil series if available,record."UNK"if the series cannot be
determined.
WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark"perched"or"apparent"as
appropriate. Record the estimated wet season water table elevation based on site evaluation,USDA soil maps,
and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present
and depth.
SOIL TEXTURE: Record soil texture or loading rate for system sizing.
DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record"NA"if not applicable.
DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other,specify type.
ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required.
-SITE EVALUATED BY: Signature of evaluator,title,and date of evaluation. Professional engineers must seal all documents submitted.
ELEVATION WORKSHEET ELEVATION OF BENCHMARK Y REFERENCE POINT IS:
BENCHMARK SITE I SITE-2 SITE 3
[+]SHOT H.I. H.I. H.I.
H.I. [-]SHOT [-]SHOT [-)SHOT
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