PL-18-3713Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 01/18/2019
Parcel Number
77 NE 106TH ST, Miami Shores, FL 33138 1121360060310
Contacts
Permit ND.: PL-12-18-3713
Permit Type: Plumbing - Residential
Work Classification: Septic/Drainfield
Permit status: Approved
Expiration: 07/17/2019
TANIA GALLONI GALLONI Owner
Mobile: 5617038657
Other:3057261627
A SUPER SEPTIC & DRAIN FIELD INC Contractor
BRYAN K ZERO
7701 W 18 LN, HIALEAH, FL 33014
Description: DRAIN FIELD AND SEPTIC Valuation: $ 6,775.00 Inspection Requests:
305-762-4949
Total Sq Feet: 0.00 11
Fees
Amount
Application Fee - Other
$50.00
CCF
$4.20
DBPR Fee
$3.56
DCA Fee
$2.37
Education Surcharge
$1.40
Notary Fee
$5.00
Permit Fee
$187.13
Scanning Fee
$9.00
Technology Fee
$5.93
Total:
$268.59
Payments
Date Paid Amt Paid
Total Fees
$268.59
Check # 1418
01/18/2019 $218.59
Check # 1415
12/18/2018 $50.00
Amount Due:
$0.00
Building Department Copy
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 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. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
January18, 2019 Page 2 of 2
K� Miami Shores Village
RECEIVED
Building Department
DEC 18 2018
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972 CPA—)
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 201�-
BUILDING Master Permit No. — V
PERMIT APPLICATION Sub Permit No.
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: III w x IO i -shot
City: Miami Shores County: Miami Dade Zip: _J.S/ 3a'
Folio/Parcel#: 11- gk3 i• O D Ir • 6,3 J O Is the Building Historically Designated: Yes NO .�
Occupancy Type: RXS' Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): d ✓as►'e %� $,,i� iq Phone#: b�
S ' 2L - to G
Address: 17 ly r_ /G (0 STJR r'A-
City: m ► 4 rnl ' s 4 o f t 9 - State: 4:1 zip:. Ilia �
Tenant/Lessee Name:
Email
Phone#:
CONTRACTOR: Company Name: 10_N&J014, .]tAnd r&Aat Phone#: 3�S•- •�L y—D11�
Address: rj'1O J 1►gOV.
City: I&A-4A State: Zip: _"dU4
Qualifier Name:
State Certification or 116gistration #-Sjtd/fV 77&U Certificate of Competency #:SA O )Awl %1 ..
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $ Square/Linear Foota a of Work: 1,00
Type of Work: El Addition El Alteration ❑New Repair/Replace ❑Demolition
Description of Work: _ORm N 1'i0i R n e &pTd.
Specify color of color thru tile:
Submittal Fee $
Scanning Fee $
Technology Fee $
Structural Reviews $
Permit Fee $
Radon Fee $
Training/Education Fee $
CCF $.
DBPR $
CO/CC $
Notary $ E5, 10
Double Fee $
Bond $ a
TOTAL FEE NOW DUE $ Z �fl • sq
(Revised02/24/2014) -:9' 9 S9
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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: 1 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 kt6nnl. 20 by
Jwho i personally know')to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Signature
- &4mm -- ' zl��
CONT R
The foregoing instrument was acknowledged before me this
day of �T)-C-( ,= 20 IF�-__, by
"Q)n "�,-r r /�� ho is personally known to
me or who has produced T 1 1 1 l� as
identification and who did take an oath.
NOTARY PU
Sign: SA
Print: YYfG Print:
MYCMMMON # GG 044602
Seal: Seal: \ 's�'.».°.L�Q`•• fiMranN»yr���pndenvrders
v+!t ANACAROLMCORREA 'w •• '
F�M 0cbbv 4, 20tj WIR
**************************************************************************
APPROVED BY %i {'�j�— Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
12/18/2018 Property Search Application - Miami -Dade County
.,, PIR(li'
R'TY'i'-4"'-PPRA1SFR
OFFICE OF TH
Summary Report
Property Information
Folio:
11-2136-006-0310
Property Address:
77 NE 106 ST
Miami Shores, FL 33138-2034
Owner
DANIEL SCARBOROUGH &
TANIA GALLONI JTRS
Mailing Address
77 NE 106 ST
MIAMI SHORES, FL 33138-2034
PA Primary Zone
1000 SG FAMILY - 2101-2300 SQ
Primary Land Use
0101 RESIDENTIAL -SINGLE
FAMILY: 1 UNIT
Beds / Baths / Half
3/2/0
Floors
1
Living Units
1
Actual Area
1,597 Sq.Ft
Living Area
1,567 Sq.Ft
Adjusted Area
1,430 Sq.Ft
Lot Size
Year Built
9,225 Sq.Ft
1939
Assessment Information
Year 2018
Land Value $230,638
2017`
$230,638
2016
$198,007
Building Value
$96,883
$96,883
$96,883
XF Value
$752
$763
$774
Market Value 1
$328,273
$328,284
1 $295,664
Assessed Value 1
$196,0791
$192,0471
$188,097
Benefits Information
Benefit
Type
2018'E
2017i
2016
Save Our Homes
Cap
Assessment
Reduction
$132,194
$136,237
$107,567
Homestead
Exemption
$25,000
$25,000
$25,000
Second Homestead
Exemption
$25,000
$25,000
$25,000
Note: Not all benefits are applicable to all Taxable Values (i.e. County, School
Board, City, Regional).
Short Legal Description
DUNNINGS MIAMI SHORES EXT NO 2
PB 41-78
LOT 15 BLK 207
LOT SIZE 75.000 X 123
OR 20833-2320 11 2002 4
Generated On : 12/18/2018
Taxable Value Information
2018
2017
2016
County
Exemption Value
$50,000
$50,000
Taxable Value
�$500700
$142,047
$138,097
School Board
Exemption Value
$25,000
$25,000
$25,000
Taxable Value
$171,079
$167,047
$163,097
City
Exemption Value
1 $50,0001
$50,000
$50,000
Taxable Value
$146,079
$142,047
$138,097
Regional
Exemption Value $50,000
Taxable Value $146,079
$50,000 $50,000
$142,047 $1 88,097
Sales Information
Previous
OR
Sale Price
Book-
Qualifcation Description i
Page
06/01/2006
$450,000
24713-
Sales which are qualified
4372
11/01/2002
$0
20833-
Sales which are disqualified as a result of
2320
examination of the deed
03/01/1972
$31,500
00000-
Sales which are qualified
00000
The Office of the Property Appraiser is continually editing and updating the tax roll. This webs ite may not reflect the most current information on record. The Property
Appraiser and Miami -Dade County assumes no liability, see full disclaimer and User Agree ment at http://www.miamidade.gov/info/disclaimer.asp
Version
A SUPER SEPTIC & DRAIN FIELD INC.
CC: SR0161772
PHONE: 305-364-0113
DATE: / -13rV
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
7701 WEST 18 LANE
HIALEAH, FLORIDA 33014
Licensed and Insured
E-MAIL: ASUPERSEPTIC@GMAIL.COM
WWW.ASUPERSEPTIC.COM
FAX: 305-364-0349
BEFORE ME THIS DAY PERSONALLY APPEARED, ZYPYol I/ WHO
BEING DULY SWORN, DEPOSES AND SAYS:
THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT AT:
—7 7 41, �-c, ti fib' l Y
Contractor Signature:
SW0 TO (OR AFFIRMED) AND SUBSCRIBED TOME THIS DAY OF
C 2018, BY: ffiys4ln :?--p 0
PERSONALLY KNOWN
OR PRODUCED IDENTIFICATION O
TYPE OF INFORMATION PRODUCED �)" f,
MAHARAI K. GONZALEZ
MY COMMISSION # GG 044602
;fir, o EXPIRES: November2, 2020
8=W Tlvu Notary Pampa Undw# *5
PRINT, TYPE, OR STAMP NAME OF NOTARY
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Notice to Owner — Workers' Compensation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTE 7
Signature•
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this day of �t(aM/I �a� 20A_.
By „� a �� \ �,� who i personally own to moor has produced
�(�� - as identification.
Notary: Aye a C. C6yytct.
SEAL: c:o'�1S? ANACAROLINACORREA
MY COMMISSION # GG 1403:
p EXPIRES: October 4, 2021
Notary Public LM dw*tRers
PAGE OF
F.I.P.1/2- r�
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N BLOCK 207
12.87'
20.1'
i
ri
20.7'
M
LOT 15
BLOCK 207
r�
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N 89'35'2D-(M)
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t /5.14'(P&M)
F.I.P.1 /2- F.I.P. 1 /2-
NO I.D. NO I.D. ® 1
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BLOCK 207
-JWIT
11' ASPHAL '
Viairi Shoes Villacje
APPROVED BY DATE
_N.E._106TH STRE
75R/W P) ZONING DEPT - - ---
PLUMBING PLANS 1 s' A. a.a .
Approved em.Date n� ME" BLDG DEPT
Disapproved —Date. SUBJECT FO CCYPLIANCE WITH ALL FEDERAL
n 1 .'r--5 A'1 Cc_"'tV Surw,ror:-
rf./-14/LU 10
NIan - I anla tamom - UuuooK
INVOICE 906-27668
PROPERTY ADDRESS.
77 NE 106' STREET, MIAMI SHORES, FL 33138
LEGAL DESCRIPTION:
LOT 15, BLOCK 207 "DUNNINGS MIAMI SHORES "
ACCORDING TO THE PLAT THEREOF, AS RECORDED
IN PLAT BOOK 41 PAGE 78 OF THE PUBLIC RECORDS
OF MIAMI-DADE COUNTY FLORIDA.
M
CERTIFICATIONS:
DANIEL SCARBOROUGH &
TANIA GALLONI
A -I TITLE & ESCROW, INC
ATTORNEY'S TITLE INSURANCE FUND, INC
WACHOVIA MORTGAGE CORPORATION
ITS SUCCESSORS AND/OR ASSIGNS
AS THEIR INTERESTS MAY APPEAR
FLOOD 701VE INFO:
COMMUNITY #
120635
PANEL & SUFFIX
0093 J
FLOOD ZONE
X N/A
DATE OF FIRM
3/02/94
BENCHMARK: N/A
FINISHFD FLOOR:N/A
GARAGE: N/A
ELEV=N/A
WELL -IDENTIFIED FEATURFS EN THIS SURVEY AND IMAP HAVE BEEN
T1 ASI1RFD TO AN F 1l%'.ITFD Iff l IZONT.IL POSITIONAL
ACCURACY OF 0.10 (F71.
i
W
)CK J
16. t?
6
F- I
N I
n
REVISION SCHEDULE:
C l-�'
�UxVIEyGg
k
PROFESSIONAL
u
—SURVEOR fiAND MAPPER
License Numper 6677 ; • • 0.
PHONE:: (954) 777-4747 •Fax (J5 7a•7- • •
5950 W. OAKLAND PK. BLVD. • SUITS e: • iJUJDER.•iPLL, F133313 •
01
• • • ••
LEGEND: • a• •
.. �� • • • ... •
M MEA. "O"
-IF---i—L— D�No'ES F, ct Lwt "��SR}k'• - Or sF0n Powen CAetS • •
Dr mu ES Waoo FENCE L+Nt F _ - Pw 0 • •
►dd`Y `/ DiJw-Fs Et GVAmN SITE • • $G • PST OF GURVATU • • • 4
a t'Ct9 Poet" Or Q,>rsaoLWD C_iatt
PCP Prmew--m �oNr3DL Par.
ABBR_EVMALIONS: • Pj< PARR • if i � •NAa 0000
Al. Apr.LENnnj • •L' • pFeet 11 Lea
CiEN.t n Lei- • • PUB PcxTrr B.FrAm +c • • • •
F CALc F-cm F� - MEAax+E POC - Po+, (v r ME E •T
CR CALC FROM RECORD k I, PRC R»,fCl Fir.. � Ctx+vAT.mE
DB DEED eooK PT POIN. Or.rAM-f#.Y
DE - DRAiNAI,. EASEMENT RW - RIGW OF WAY
QMF. DnAmo MAW-TNANCE EASEMENT RP FlAom PcwT
.] - CENTRAL ANGI F SBR SOLTFERN Joi RISER
EASE EASEMENT UE UTILITY FLEMENr
F F FHS:4ED Flom WIC W11w3s Corx_n
FIND - FouND WrM WATrR MFr. a
FPL FLoFmA PTmEa & LchT
N(n'ES:
I. THS SURVEY IS BASED UPON RECORDED INFORMATION AS PROV13ED BY CLIENT NO
SPECIFIC SEARCH OF THE PL 13M RECORD HAS e:EN MAD_ BY TY-S OFFxE
2. UNDERGROUND PAPROVEAC.'JTS HAf NOT BEEN LOCATED EXCEPT AS SPECIFICALLY
SHOWN.
3. _LCVATIONS ARE BASED UPON hAT.ONAL GEODETIC VERT'CAL DATUM '"2 (N.G.V.D 19,m
4. FENCE TES ARE NOT C"NTERUNE OF FENCE.
5. IN SOME CASES. GRAPE C RE^FtiSCWATKM HAVE BEA EXAC3EEATED TO MORE
C:EAR_Y ILLUjTRATE VEA RM RELATION-K;'S-D9'71S:DkS Sh'11 HAVE PRECEDENCE
OV_R COALED P077IONS.
6. ALL Da:ENSKM SHOWN ARE FIELD MEA..�'RED AND CORRESPOND TOR-=
INFORMATION UIIESS SPECIFICALLY NOT=D OTH". MASE
7, DATE OF OTCUL Fl1D WORK. ,S if ?- 06
e. INILCS$ OTHERraE CXCF--J. MIS SM EY IS NOT TO BE USED FOR CONSTRUCTION
PURPOSES
SURVEYOR'S CERTIFICATION:
I HEREBY CERTIFY THAT TMS _BOUNDARY
SURVEY MEETS THE 1=41=11.1i TECHNICAL STANDARDS FOR SURVEYS, AS
S-,T FORTH OY THE FLORZA BOARD OF SURVEYORS AND MAPPERS IN
CHAPTER SIG17-6 OF Tt:E FLORIDA ADMINISTRATIVE CODE, PURSUANT TO
SECTION 472.fYt7•-FLdri:DA STATUTES.
BEAAIA(t:S, IF S+IOWN, ARE BASED UPON AN ASSUMED MERIDIAN
AND REFERIENCS ON
00-476
DATE:
Va:IIom B. Groover, Professional Surveyor & MgVer
Florida Registrattori No. 5190
_ (not valid without the signature and original seat of the
Florida Licensed S. rveyor and Mapper shown above)
hHnc-Uni itlnnlr live rnm/mail/centiteme/iri/G()AAieAnAuiATF(V1TA%A/A-OORAi7iI T9=nNi(1tAAr1G(:ITA,ed:nR(:AGArl47(:,uirCil4inciiIRVR411hr)rA\/Ief, iMi im 1/1
a
_ t
R E-- P A I
MIAMI-DADE COUNTY HEALTH DEPARTMENT
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
PERMIT #:13-SC-1905434
APPLICATION #: AP1385440
DATE PAID:
FEE PAID:
RECEIPT #:
DOCUMENT #: PR1182906
CONSTRUCTION PERMIT FOR: OSTDS Repair0.
• • • • •
APPLICANT: Tanta Gatloni
0
•
••
• • •
PROPERTY ADDRESS: 77 NE 106'St Miami, FL 33138
•'• •: • •
•
• • • • • • • :.
LOT: 15 BLOCK: 207 SUBDIVIdION: Dunnings Miami Shores
•t••
;'•••• ' •
'
ESECTION, TOWNSHIP, RANG$•,%ARCEL N~• ••i•••
PROPERTY ID #: 11-2136-006-0310
[OR TAX ID NUMBER]
•�••
•• •
SYSTEM MUST BE CONSTRUCTED IN ACd016ANC9 r WITH SPECIFICATIONS
•
AND w9TVbPDS • O!'••.•SECTION••••
381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL [)F
SYSTEM* DQES
N096 CUARAN366.,,:
SATIS'r;ACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIMS.. ANY
CWGE IN MATE&JU• FACTS, •
WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT
TO: MODIFY THE
PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT
BEING MADE
NULL AND VOID.
j
ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH
OTHER FEDERAL,
STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ] GALLONS / GPD septic tank CAPACITY
A [ ] GALLONS / GPD CAPACITY
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS]
K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PEAR 24 HRS #Pumps [ ]
D [ 225 ] SQUARE FEET Trench configuration drainfi SYSTEM
R [ 0 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: Ex1 STANDARD [ 1 FILLED [ ] MOUND [ 1
I CONFIGURATION: [u] TRENCH [ ] BED [ ]
N
F LOCATION OF BENCHMARK: FFE 12.5' NGVD
I ELEVATION OF PROPOSED SYSTEM SITE [ 22.801E INCHES FT ][ ABOVE BELOW BENCHMARK/REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 57.80][ INCHES FT 1[ ABOVE BELOW BENCHMARK/REFERENCE POINT
L
0
T
H
E
R
-1" nzwu lzu- L j INCHES EXCAVATION REQUIRED: t 50.UU j INCHES
"THIS REPAIR PERMIT IS NOT FOR ANY ADDITIONS"
1.-Install a 900 gat min. septic tank with an approved filter.
2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance
with s. 64E-6.013(3)(f), FAC.
3.-Install 225 sf of drainfield in trench configuration.
4.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench.
(Comments Continued on Page 2.)
SPECIFICATIONS BY: A Super Septic
TITLE:
APPROVED BY:
klaa2�
TITLE: Engineering Specialist II
Dade CHD
Erlande Omiaca
DATE ISSUED:
11/30/2018
EXPIRATION DATE:
02/28/2019
DH 4016, 08/09
(Obsoletes all previous editions which may not be used)CONTRACTOR...
CO
S�l.�4R1NG
Incorporated:
64E-6.003, FAC
v ! 1 a
API'.45440 The O! j%!i W. Vot Cl= ...:t"!C`) s rrr;,j
-,I t? r-r,;3, 't A .0 hae; iq
s
d
DOCUMENT # : PR1182906
5.-Invert elevation of drainfield to be no less than 8.18' NGVD. : •' :"• •
6.-Bottom of drainfield elevation to be no less than 7.68' NGVD. • ' • •
7.-This permit includes the abandonment of the existing septic tank. 0 : •' 0 •• •'
The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimatedflow of 309
gpd- ••••.' :•..:•
•••..•
•• .
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR CONSTRUCTION PERMIT
Permit Application Number,
---------------------------PART II - SITEPLAN---------------------------
Scale• Each block represents 10 feet and 1 inch = 40 feet
1:
11■■■■■■■■I■I
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L�>■
ICI
ii■!■�
■■�
e
11■■
■■■■■■■1
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1,
11■■
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11■■
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1■■■■■■■Ili■■■■11
Notes: REPAIR ENTIRE SEPTIC SYSTEM COMPROMISED. INSTALLING A NEW 900 GALLON SEPTIC TANK &
225 S.F IN TRENCH CONFIGURATION D.F
HOUSE HAS BEEN UNINHABITED FOR MONTHS, NO WATER CONSUMPTION WAS OBTAINABLE.
Site Plan submitted by:
Plan Approved
By
Not Approved
CONTRACTOR
Date 11-29-18
_ County Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC
(Stock Number: 5744-002-4015-6)
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