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1240 NE 91 Terr (4)1 A • • ••• • • • ••• PERMIT'A P�,I f 3ONI FOR MIAMI SHORES VILLAGE • • , • Q 10050 N.r,. 2nd Avenue • Mtamt S h'low 33138 • Phone: 305- 795 -2204 • Fax: 305- 756 -8972 Date — �u "Q Job Address )ay a - 9/,T£r ••• Tax Folio 11-_306:5-&01-03(10 • • • • •,• • • • / ,�! •, • • , ( Legal Description .,0 ,29 'F 1v LIftkr :cd,f: tliytorically Designated: Yes No Owner /Lessee/Tenet Master Permit # -2 Z0034 0 •• • • • •• ••• • Owner's Address • . Phone ' •• • • • ; • Contracting Co. OA/ A f iI1 1 J S. pi 1e S tJC Address ? 0 °' Y ` 7 t R // lei am 1 33.2q3 Qualifier l 14441 k 1 e l CA's, pi. E YYl641'1 Square Ft. .s �S re of owner and/ `► as to Owner and/ ssion FEES: PERMIT `/ /� • d,/ ' •• • • • • • /o2'GV /7 LL L j ` L'p ' •• State # 9-s- l 1 b Municipal # IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY, THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE BEFORE CALLING FOR ANOTHER INSPECTION. Permit Type (circle one): BUILDING ^ ELECTRICAL ' a WORK DESCRIPTION: i-t .911ti lv; WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANY ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for all disciplines. 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. Furthermore, I authorize the above named contractor to do the work stated. 6 ndo President Date I ifisioiloil \ a _ ,2 $ - O J ondo P`szr, ;gji •qti 4 O& st 26, 'I A • i ���V 2 0 7 Z =* O. •4 N : *5:" #DD 144837 a Q dmN • a' O / ,,,/ A I 1 111111 \ APPROVED: Zoning Building Mechanical Plumbing Date •• C.C.F SS# (263 - 76`/ O Phone (i Y41 ' C (a ?5 = Estimated Cost (value) # Competency # Ins. Co. /101/0, W G Signor PLUMBING MECHANICAL ROOFING ractor or Owner Builder Notary as to C My Commissi$n Eiir ° O.•41, I * *: • .:? #DD 144837 ; o` a414/1c . ;�a 41 (SZ N ... 4 ��� BON --' svot /4/41111111000` 1 f f TOTAL DU r& , /- 6;-103 Date t •)6 Date Electrical Structural Engineer Applicant: JAMES Owner: JACKSON JOB ADDRESS: 1240 NE 91 Local Phone: NJ For Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 1/31/2003 Contractor CHAPMAN SEPTIC SERVICE, INC. Fees: FEE2003 -667 FEE2003 -668 FEE2003 -669 Description CCF Bukhara Bond Building Fee Total Fees: P 44 4 Permit Status: � Work: INSTALL 300 SQ. FT. DRAINFIELD Is .�.___ CHAPMAN SEPTIC SERVICE INC. P.O. BOX 431914 MIAMI, FL 33243 -1911 Pay r the m o o s ) ` U order of U /LJL Bank of America. APPROVED Permit Expiration: 03-99 11'00548011' 1:063 L00 2771: 00 36 E Plumbing Permit Permit Number: PL2003 -40 JACKSON JAMES TERR Contractor's Address: P. O. BOX 431911 Parcel # 1132050010540 Legal Description: 5 53 42 WATERSEDGE 7/30/2003 Amount $1.20 $300.00 $80.00 $381.20 Construction Value: Date d` 6-3 0144 4 /4 Dollars 8 $2,000.00 5480 63- 27/631 FL 987 Page 1 of 1 PB 9 -141 E2OFT LOT 29 & LOT 30 LESS ELY 5FT Total Fees: $381.20 Total Receipts: $0.00 e- inspection ation herefor in strict compliance with all cations that may have been submitted to or if the plans are changed without 7nsibility for a thorough knowledge of the iat he assumes responsibility for work done s pertaining thereto and in strict conformity esponisibility for all work done by either CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Jackson, James & Marlene PROPERTY STREET ADDRESS: 1240 NE 91 Ter Miami FL 33138 LOT: 29 BLOCK: 2 PROPERTY ID #: 11- 3205 - 001 -0540 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATERIAL 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK MULTI- CHAMBERED /IN SERIES: [Y ] A [ 0 ]Gallons MULTI- CHAMBERED /IN SERIES: [Y ] N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 )GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 300 ]SQUARE FEET PRIMARY DR.AINFIELD SYSTEM R [ 0 ]SQUARE FEET ti SYSTEM A TYPE SYSTEM: [ - ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH [y' ]BED [ N ] N I F LOCATION TO BENCHMARK: Top of Bottom Floor, 6.00' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE [ 0.7 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 2.2 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES OTHER REMARKS: This permit is not for addition(s). *Existing 900 gl. septic tank to remain. *Install 300 sq.ft. of drainfield. f' *Invert elevation to be no less than 4 . 3 0 ' NGVD. I N S T A L L 1 2 Or SItGHH'LY *Bottom elevation to be no less than 3.80' NGVD. D. O � �, j �0�. *Install 12" of slightly limited soil under bottom of wider i:e1 `' . i m.., Perimeter of excavation area shall be at least 2 ft. wider E;,7, `` r :Q �rl _ 9.148) and longer than the proposed absorption bed or drain tr ' Ply' -,,: �_ : :t%1 - �`'' ' Tr A? L �1' 2 1 : `v` /ii: ? 1� 1J LOI' G II: A E PROPOSED AB30i'p fC�I� QED OR D TEIE: I: +3TaLLED v.7 I:JC 6L Y: SPECIFICATIONS BY: Icaza, Carlos APPROVED BY: Icaza, Carlos DATE ISSUED: 1/2/03 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE GEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) fostds cons 4016 -1) ]Holding Tank [ ] Innovative Other )Temporary ( NA ] AGENT: SR0941167, CHAPMAN CHARLES SUBDIVISION: Water Edge [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] TITLE: TITLE: Engineer I CENTRAX #: 13 -SG -15074 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 02 -3683- -R Dade CHD EXPIRATION DATE: 4/2/03 Page 1 of 2 STATE Ok' FLORIDA ! DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS +; PLICANT: /2/k/ LbT: 9 x_ 3 0 BLOCK: SUBDIVISION: PROPERTY ID #: // - _ © ( - Q �.. JL3ct on /Townshi PROPERTY SIZE CONFORMS TO SITE PLAN: TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS THE MINIMUM SETBAC SURFACE WATER: WELLS: PUBLIC: BUILDING FOUNDATIONS: SITE SUBJECT TO WHICH FT FT CAN 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFORMATION SITE 1 /00 BE MAINTAINED FROM THE DITCHES /SWALES: MITED USE: 4 FT FT PROPERTY LINES: FREQUENT FLOODING: [ ] YES 3BSERVED WATER TABLE: / / // ( J INCHES [ABOVE ESTIMATED WET SEASON WA ER TABLE ELEVATIO HIGH WATER TABLE VEGETATION: [ ] YES [ NO SOIL TEXTURB RAT FOR SYSTEM SIZING: DRAINFIELD CONF ON: [ J R ,, E ,, N� jj [ . REMARKS /AD ION CRITERIA: A t o SITE EVALUATED BY: DH 4015, 10/96 (Replaces HRS -H or 4015 (Page 31 (Stock Number: 5744- 003 - 4015 -1) ch may be used) YES [ GALLONS GALLONS SQFT s1L (07 PERMIT # NO NET USABLE PER DAY PER DAY [1500 GPD /ACRE UNOBSTRUCTED AREA REQUIRED: ENCES -TABLE 1• (oo DEPTH OF EXCAVATION: HER (SPECI Y) Range /Parcel'No( or Tax ID Number] TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR R QUALIFIED PERSON PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. CO LETE ALL ITEMS. ENGINEER'S MUST LE: (O, J r) ACRES 1 OTHER -TABLE 2] 504 GPD /ACRE] A�( SQFT /FT] [ABOVE BENCHMARNfREFERENCE PO3I IT PROPOSED SYSTEM TO THE FOLLOWING FEATURE . FT NORMALLY WET? [ ] YES [ NO P RIV TE: F N ON- POTABLE: FT FT POTABLE WATER LINES: A f FT /t N �j [1 NO 10 YEAR FLOODING? J YES NO FT MSL /NGVD SITE ELEVATION: S 6 FT MSL /NGVD SOIL PROFIS'E ' fQRMA'{'ION SITE 2 1 X Munsell Color 4 / y &Linn \ to to to n —XL 'A - J.11 USDA SOIL SERIES: ext pepth t o to- to ,; 29 1 ___to XISTING GRADE. TYPE: [PERCHED _ INCHES [ ABOVE / : LOW ] EXISTIN GRADE. RADE. MOTTLING: [ ] YES [ NO 'EPTH: " INCHES ] INCHES DATE ; 42 "t Page 3 of 3 By Site Plan submitte Plan Appr'v STATE OF FLORIDA DEPARTMENT OF HEALTH PPUCA:ION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIOI, Permit Application Numb PART II - SITEPLAN 'Scale: Each block represents 10 feet and 1 inch = 40 feet. DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 - 002 -4015 -6) 3 F 6r i -: 3&83 'ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Iciter� Est Not Approved Date n1 —o Z — �'3 County Health Department Page 2 of 4