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PLUMBING PERMITT A N K D R A I N F I E L D 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: 9, STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC CONSTRUCTION PERMIT F»R: O New System [ /%"..Existing System [ Holding Tank [y] Repair ( ] Abandonment [,L Other(Specify) APPLICANT: E ��t k/ '� C{ Ai AGENT: Sac fir PROPERTY STREET ADDRESS: S-0 It / I L-- e 7, / LOT ( 4 j � I r4CK : C 'J SUBDIVISION: E / Pc) PROPERTY ID #: I 3 O /' Q ` O 0 [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER) [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 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 SPECIFIC PERIOD OF TIME. 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. SYSTEM DESIGN_AND SPRCIFICATIONS 0 <- ] � GALLO�/ GPD] TIC TANK7AEROBIC UNI [ ] [GALLONS / GPD] [ ] GALLONS GREASE INTERCEPTOR CAPACITY [ ] GALLONS PER DOSE DOSING TANK CAPACITY (2.- KUARE FEET PRIMARY DRAINFIELD SYSTE [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND CONFIGURATION: ( ) TRENCH [GIBED [ 1 -y- ELEVATION OF PROPOSED SYSTEM SITE [ /2_—] T] [ABOVialiETZWr BENCHMARK/'ERENCE` BOTTOM OF DRAINFIELD TO BE [ Z_ J/) [ABOV$` /BELOW] j1ENCHMARK/ EFERENCE POIN BOTTOM OF _. :1., _ DH 4016, 10/96 (Replaces HRS -H Form 4016 [page 1] which may be used) (Stock Number: 5744 - 001 - 4016 -0) FILL REQUIRED: [ ] INCHES r , EXCAVATION REQUIRED: (3 (2)) INCHES TITLE: Installer /Contracter CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] CITY MULTI- CHAMBERED /IN SERIES:( ) [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] DOSE .RATE [ ) PER 24 HRS NO. OF PUMPS: [ TITLE: CHD [ G_. P te. / PERMIT # r7 1( DATE PAID FEE PAID $ RECEIPT 1 337u Temporary /Experimental F Gd, r , .)F C [ EXPIRATION DATE: 3- i f� q, ; Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. 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 street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 1OD -6, FAC. DRAINFIELD: Minimum specifications from Chapter IOD -6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. Scale: Each block represents 5 feet and 1 inch = 50 feet. 135 Notes: 1 ?) uVC e" 0 11 Sc '3;1 ?)8 • 1 Qv 5 6 Site Plan submittedpy: ) Plan Approved • 7 7' - 0474, .." rr, . . By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PER Permit Application Numbel PART II - SITE PLAN- ' Ser OtOk 0 or-t .P/ QL/! c4;0, Signature Title Not Approved Date /2_-' ' 7 4 - f County Health Department 100 ALL CHANGES MUST BE APPROVED BY THE,COUNTY HEALTH DEPARTMENT ); . Is.LV Dfl 4015, 10/96 (Replaces HAS Form 4015 which may be used) (Stock Number: 5744-002-4015-6) _ _ .14 _ _ -n■-■ S. - - Page 2 of 3 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This appli is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. ' Owner's Name and Address-____ Registered Architect and /or Engineer Employing Plumber's Name_ a ^�vt� Location and Legal Description Lot OF FLORIDA, COUNTY OF DADE. Amount of Permit $ # 6-J ss. S' Block (Signed) (Signed) No Street Date__ Type of Tank r Subdivisio meiliteet Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories r ' Capacity Gals Size Septic Tank Feet of Drain Tile Nature of Water Supply: City —Well Size of Soakage Pit Dist. Feet of Tank or Drain Field from Well Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he un'l.tands and accepts his ob as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen Laws of Florida Puma Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commis Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and7or workmanship. ' 1 CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT 'NS TOTAL FIXTURES CONTR. LIST CHECK I SEPTIC TANK SEWER NN. DRAIN FIELD 1 SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST - . CHECK MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This appli is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. ' Owner's Name and Address-____ Registered Architect and /or Engineer Employing Plumber's Name_ a ^�vt� Location and Legal Description Lot OF FLORIDA, COUNTY OF DADE. Amount of Permit $ # 6-J ss. S' Block (Signed) (Signed) No Street Date__ Type of Tank r Subdivisio meiliteet Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building Remodeling Addition Repairs No. of Stories r ' Capacity Gals Size Septic Tank Feet of Drain Tile Nature of Water Supply: City —Well Size of Soakage Pit Dist. Feet of Tank or Drain Field from Well Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he un'l.tands and accepts his ob as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen Laws of Florida Puma Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commis Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and7or workmanship. ' 1 /✓ 1 f STOCKTON, WHATLEY, DAVIN & COMPANY Miami Shores Plumbing Department Miami Shores pillage y— , 10050 N. E. 2nd Avenue ��,�//, t aami Shores, Fla Re: BROilN, Joh C 9181 8 , Fla Mi 50 IA. E. 91st St. Gentlemen: MORTGAGE LOANS AND INSURANCE 1411 DUPONT BUILDING MIAMI 32, FLORIDA December 13th, 1950 There is attached in triplicate rlumbing Certificate, in connection with the above case property. Aft..r the final plumbing inspection has bon made, please have the Plumbing Inspector execute these forms and return to this office. /mt encl Very truly yours, D. J. Pawls Permit No Q ei �� MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date - - (, LC— - , Z Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. G� Owner's Name and Address ............ _ - _ -- No.� Street. _IV -, Registered Architect and /or Engineer ------ . — -- Employing Plumber's Name Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed and purpose of building (By New Building _ -- Remodeling Size Septic Tank 0 Amount of Permit � — _ - f STATE OF FLORIDA, } COUNTY OF DADE. Block Floors) - _ - _ 0_,177:: -6__ Addition (Signed)- (Signed)_ No.ZA 31 Subdi Street.__ .. Repairs No. of Stories Feet of Drain Tile _______ -____- _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well ._ Si of Soakage Pit My Commission Expires Notary Public, State of Florida ,F 44.1' Type of Tank_ Capacity Gals. Plumbing In ctor. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit. as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the__ of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made 'necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHICK -- SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL C LIST 139,44 r CHECK Permit No Q ei �� MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date - - (, LC— - , Z Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. G� Owner's Name and Address ............ _ - _ -- No.� Street. _IV -, Registered Architect and /or Engineer ------ . — -- Employing Plumber's Name Location and Legal Description Lot Street and Number where work is to be performed —No State work to be performed and purpose of building (By New Building _ -- Remodeling Size Septic Tank 0 Amount of Permit � — _ - f STATE OF FLORIDA, } COUNTY OF DADE. Block Floors) - _ - _ 0_,177:: -6__ Addition (Signed)- (Signed)_ No.ZA 31 Subdi Street.__ .. Repairs No. of Stories Feet of Drain Tile _______ -____- _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well ._ Si of Soakage Pit My Commission Expires Notary Public, State of Florida ,F 44.1' Type of Tank_ Capacity Gals. Plumbing In ctor. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit. as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the__ of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made 'necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date. - _ —....... - '� Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submiticd for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mis. ^t Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulaticr of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specfications must be kept at building during progress of work yy�� p 11 � Owner's Name and Address T _d.�� �%� __.._ No.___ Street!_Z.+�..2.L.._.S degistered Architect and /or Engineer .mploying Plumber's Name 4 . L _ L _ C l Lii /? I ✓✓'i 4 JA NO,. - -. .. ki 4 7 e. 8tleet . .,. � r Subdivision__ -- _ - - -.— Location and Legal Description Lot Noel Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)___... __....__.______._ N B Remodeling_ _ ___.__ Addition...- ✓ Repairs No. of Stories.. . Street Size Septic Tank_.— .--- _--- •-------- _ - - - -- ..Type of Tank__ Feet of Drain Tile._.— _ —_ .Dist. Feet of Tank or Drain Field from Well . - Nature of Water Supply: of Soakage Pit Amount of Permit $ ! 40 (Signed) _ STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires (Signed) Capacity Gals. Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent rum lement, and has con - plied with the provisions thereof, and will require similar compliance from all contractor or sub - contractors a ployed t Iim in r wcrk o h- performed under this permit; and will post or cause to be posted for inspection on the s of the work suc publ: noti -e r no ices as ar required by the Act. The undersigned agrees to employ only such sub- contractors, • • k to be pert ed ? t p licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personal i ppeared, to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the ..- ___ .... .... ......... ...... _ ...._ _.. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all 'acts therein by him stated are true. Notary Public, State of Florida Mastn Plumber. NOTE: A re inspection fee of $1.00 will be made when such re is made necessary by improper notice for Inspection, or *suit) materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY Tugs URINALS CATCH eASIN FLOOR DRAIN DRINKING FOUNT•N! TOTA.L FIST( RES -- CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'O P001. CoNTR. LIST r-- CH[CK I Permit No. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Date. - _ —....... - '� Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submiticd for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mis. ^t Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulaticr of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specfications must be kept at building during progress of work yy�� p 11 � Owner's Name and Address T _d.�� �%� __.._ No.___ Street!_Z.+�..2.L.._.S degistered Architect and /or Engineer .mploying Plumber's Name 4 . L _ L _ C l Lii /? I ✓✓'i 4 JA NO,. - -. .. ki 4 7 e. 8tleet . .,. � r Subdivision__ -- _ - - -.— Location and Legal Description Lot Noel Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)___... __....__.______._ N B Remodeling_ _ ___.__ Addition...- ✓ Repairs No. of Stories.. . Street Size Septic Tank_.— .--- _--- •-------- _ - - - -- ..Type of Tank__ Feet of Drain Tile._.— _ —_ .Dist. Feet of Tank or Drain Field from Well . - Nature of Water Supply: of Soakage Pit Amount of Permit $ ! 40 (Signed) _ STATE OF FLORIDA, COUNTY OF DADE. My Commission Expires (Signed) Capacity Gals. Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e of labor under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent rum lement, and has con - plied with the provisions thereof, and will require similar compliance from all contractor or sub - contractors a ployed t Iim in r wcrk o h- performed under this permit; and will post or cause to be posted for inspection on the s of the work suc publ: noti -e r no ices as ar required by the Act. The undersigned agrees to employ only such sub- contractors, • • k to be pert ed ? t p licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personal i ppeared, to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the ..- ___ .... .... ......... ...... _ ...._ _.. of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all 'acts therein by him stated are true. Notary Public, State of Florida Mastn Plumber. NOTE: A re inspection fee of $1.00 will be made when such re is made necessary by improper notice for Inspection, or *suit) materials and /or workmanship.