Loading...
PLUMBING PERMITBUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Lot Description MIAMI SHORES VILLAGE, FLORIDA ❑ PERMIT N° 14327 Subdi- vision (_l DATE /1 2 ❑ Work to be performed under this Permit 195 Contractor's License No Address of r Value of Amt. of . Building 1 "� 'L � '% 1.) • '" C . ~ J . -«s,, Project $ Permit $ -: This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or .in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed, P.J \ . i� 'rt-;. 4 ...+ BY ( .'' ..� _. 1, " "' INSPEc4OR 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, statemen< or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume res onsibility for all work done by either, myself, my agent, servant or employee. 1 ( - `' - .. L 1..--1... am / CON O R / BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMBNG ROOFING Owner of Building Architect Contractor or Builder Legal Lot Description. Address of Building PERMIT IN? 12544 f] Work to be performed under this Permit CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Bl. Subdi- vision Value of Project $ DATF Contractor's License No 1 4 Amt. of Permit .i • 195 war This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. . Signed j- - BY INSPECr9R 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, servant or employee. BY AUTHORITY Permit No 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. Feet of Drain Tile STATE OF FLORIDA, COUNTY OF DADE. Owner's Name and Address-___ . _&t2 - __ Registered Architect and /or Engineer. Employing Plumber's Name Location and Legal Description Lot -, ` �il.52A MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEN's' APPLICATION FOR PLUMBING . "' ;LA OT Street and Number where work is to be performed —No. ...t.e > Block_ State work to be performed and purpose of building (By Floors) New Building _ -- Remodeling -- Size Septic Tank Type of Tank Capacity Gals Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $ .e/__- ___-------------- - - - - -- — -- (Signed) - No- _ 12.3 Street-._ Wg 9? Street - Subdivision._f - . Street_- /=A jf 0 Addition________._._.___ _.__._ Repairs No. of Stories Plumbing Inspector. 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 Worlanen'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 tiie 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. (Signed)._ Date My Corrunission Expires Notary Public, State of Florida ,6. 30 ,/ �'Y'���'s��z 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. 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 URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIST a. / / 3 Q! �- -- CHECK . SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP Sosofee HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST / - - -- CHECK Permit No 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. Feet of Drain Tile STATE OF FLORIDA, COUNTY OF DADE. Owner's Name and Address-___ . _&t2 - __ Registered Architect and /or Engineer. Employing Plumber's Name Location and Legal Description Lot -, ` �il.52A MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEN's' APPLICATION FOR PLUMBING . "' ;LA OT Street and Number where work is to be performed —No. ...t.e > Block_ State work to be performed and purpose of building (By Floors) New Building _ -- Remodeling -- Size Septic Tank Type of Tank Capacity Gals Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $ .e/__- ___-------------- - - - - -- — -- (Signed) - No- _ 12.3 Street-._ Wg 9? Street - Subdivision._f - . Street_- /=A jf 0 Addition________._._.___ _.__._ Repairs No. of Stories Plumbing Inspector. 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 Worlanen'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 tiie 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. (Signed)._ Date My Corrunission Expires Notary Public, State of Florida ,6. 30 ,/ �'Y'���'s��z 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. 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 / r I 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 Vi11 e, 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 Buildin Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be`ks. at building during progress of work. l . �v Owner's Name and Address Registered Architect and /or Engineer qr r _ / Employing Plumber's Name L'2 ` C-s? �'-e '«``t^.�{, t 1 '' No. L_S 3 4 Street_ 611 7 Location and Legal Description L lock � Subdivision Street and Number where work is to be performed —No L ________A'r X , Street 9' 3iI-"e LC-'r State work to be performed and purpose of building (By Floors) uildd ng Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank____ Capacity Gals Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply ity 1We11 F oD ______ of Soakage Pit STATE OF FLORIDA, COUNTY OF DADE. ss. My Commission Expires Amount of Permit $ :2 (Signed) (Signed) Plumbing Inspector. 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 tinder 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. Notary Public, State of Florida Master Plumber. 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 URINALS CATCH BASIN FLOOR DRAIN DRINKING FOU NT' NS Nt.T Q / I! �U�c I� Pl /2. TOTAL FIXTURES CONTR. LIST / /, /� CHECK . S' /I J ? S I / 3 L) 7 J ✓ / f y f� / { ] SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP MR A HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL �� CONTR. LIST -_ i# ()(: / CHECK SO Permit No. ,MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT • Date / r I 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 Vi11 e, 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 Buildin Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be`ks. at building during progress of work. l . �v Owner's Name and Address Registered Architect and /or Engineer qr r _ / Employing Plumber's Name L'2 ` C-s? �'-e '«``t^.�{, t 1 '' No. L_S 3 4 Street_ 611 7 Location and Legal Description L lock � Subdivision Street and Number where work is to be performed —No L ________A'r X , Street 9' 3iI-"e LC-'r State work to be performed and purpose of building (By Floors) uildd ng Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank____ Capacity Gals Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply ity 1We11 F oD ______ of Soakage Pit STATE OF FLORIDA, COUNTY OF DADE. ss. My Commission Expires Amount of Permit $ :2 (Signed) (Signed) Plumbing Inspector. 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 tinder 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. Notary Public, State of Florida Master Plumber. 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 APPLICATION FOR MIAMI SHORES VILLAGE Date 2 5 0 Job Address 123s Ne 3 ST Tax Folio it' 3205 02 0 04 -0 Legal Description to 4 5 ll b (JCIVj LwvC, Historically Designated: Yes No Owner/Lessee / Tenant Man S iym T n \J Owner's Address 235 gE c71 3 S S io(°S 3o` t Contracting Co. SecAC COV) rNQ C-k Q r) g i fl C Address (AP 0 g 1 Ar,x, $ Z 3 M I Aorvtl 3 3 Qualifier TeX eSc ("'' k °CY\wn SS# , � Phone 0606G1-6-63.3 State # 3 1 )\ - oci �v a 8 Municipal # Competency # Address Architect/Engineer N Bonding Company ki t\ WORK DESCRIPTION 6 Signature of owner and/or Condo President Date Notary M Co • xp =c >° J. SOLOMON MY = 6M ISSION # CC 854606 ` EXPIRES: Jul le, 2003 i NOTARY NMI/ tunics & Bonding Co. FEES: PERMIT � RADON Irb4, L14 ' Date Zoning Building Mechanical Plumbing Address Master Permit # Phone (:) 1S4- - ! SS Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL IKUMBI*G MECHANICAL ROOFING PAVING FENCE SIGN 1 nskcAk 1 C sfev Square Ft. , 0 0 Estimated Cost (value) At 9 500 23 Ins. Co. ti au fit 0 t 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 AN 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 ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above -named contractor to do the work stated. Date as to on My Commission c '. + i III' - Q �r (:) MY COMMISSION EXPIRES F OF F■ NOV. 15,2002 ate C.C.F. ! D NOTARY S. o 0 BOND' d , APPROVED: TOTAL DUE 3 / Electrical Structural Engineer AR SEAL �PA BECKER COPMBSS1ON NUMBER CC786697 APPLICANT: f� Tfr AGENT: ^ ,p( A f� S�P�f l G C�7r� C t 4� LOT: ct S BLOCK: SUBDIVISION: BosAl LIAR e PROPERTY ID #: O21 -00'-0 TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [ ] YES (L4 NO NET USABLE AREA AVAILABLE: . ACRES TOTAL ESTIMATED SEWAGE FLOW: 200 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2) AUTHORIZED SEWAGE FLOW: (0 0O GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: 4-Q0 SQFT UNOBSTRUCTED AREA REQUIRED: 100 SQFT I BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS 2.G [INCHES / [ABOVE /T!!!!] BENCHMARK /REF NC `PyINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: N FT DITCHES /SWALES: N A FT NORMALLY WET? [ ] YES [ WELLS: PUBLIC: N A FT LIMITED USE: N A FT PRIVATE: NA FT NON - POTABLE: N i FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: In FT POTABLE WATER LINES: 1C) FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES pl NO 10 YEAR FLOODING? [ ] YES [s.(NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: 5.1 FT MSL /NGVD W.T. 3.o SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture Death l0 \IR+s'1 e)(6 L0\( S ) C 11 too ?, II to to to to to to to to USDA SOIL SERIES: �� () OBSERVED WATER TABLE: KI R. INCHES [ABOVE / LO ] EXISTING GRADE. TYPE: PERCHED / A T] ESTIMATED WET SEASON WATER TABLE ELEVATIOy: 32.4 INCHES [ ABOVE / BELO• ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [ANO MOTTLING: [ ] YES [0140 DEPTH: INlA INCHES SOIL TEXTURE /LOAD'ING RATE FOR SYSTEM SIZING: ). O DEPTH OF EXCAVATION: (8 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [L/']' BED [ ] OTHER (SPECIFY) `'' REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BIY: DH 4015, 10/96 (Replaces HRS- (Stock Number: 5744- 003 - 4015 -1) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS i 15 [Page 3] w ay be used) [Section /Township /Range /Parcel No. or Tax ID Number] F e 3' 1235 N(5 73 ST 33138 PERMIT # c SOIL PROFILE INFORMATION SITE 2 Munsell , Color Texture Depth I , R°� ► to �l S4149 DI to 12 I to USDA SOIL SERIES:U, to to to to to to to DATE: ��Ib1 Page 3 of 3 IN'IlTRUCTIONS PI RMI"i' Nt N11;1 f l' rmit tracking number by t;nun health Pep..rtnKrit. AII'Lit':A 'I 1 ri, e r:. rna TIC! s tr it flame AC,1•.N 1 1..0I., III .tK is s( ;lii)tdltiit)N , tnd z n d lstr�n !nr lot PROPI • RTC" Iit VI` ?tt31 R h.!'xi...!el numh;l I )f prop:recta, (pr PROM..RP. stih SL4) ; i i.t))1; • UNt)liS ! Rl.t.' 1; B}• I1 \ -rth ! ^ :l 1 if > 'ti1t i'1 ' s' `, I'kt;ilt 1, i:;tt?R\. /, r1'7'. 1 .\AI1 -14 /• \!1 DRAINFiI 1.1) CON'FI( CI;iti ADDITIONAL (RITERiA: SLID I'.VALL A i'Itl) 3Y L:L.t ?VAIION WORK SIIL)� "T BENCHMARK ( '+ SL147r H.I. t'rtater :F toant.r • itt - ali4 altthnr1Lrd ten +, -CO euage 1111 V fur do: •st:. :.s i t" i A Record the at t 1lr:r , per : , per der: (Gt. pr 'i :1' u! :t;;gr !t■' 60C' 101,1 , 1 •> , run' t!t ura.r.rst:ttu.t..1 u, the r:.inli.:lt: .1 rt.ecrel [':_ Ia n'. nth: 1•.'1_ltnrnrk ti!r n ;■i it ,•..d)hc n!nrrrc;ti,c t snit ptofilet :vithin the prop: .1st 1 • idr will it;er I.IS1)A Soil ( r•,. ., rout he ele:rl} ;L-_t.r..crited Pro ei t :. 1c-t. rro fed Pei —.. led the der•ih .11 the observed eater thie epptaptiatr. Rcettrd the estrrrtated uet ,ea ts) v,at r r:t!• meal ittstnrr ;al information i;tdic•)t' there i Ind :let „ li S()11 "'1E.% I 1 10i: !2etotd soil tcatur_ or loadin;i rate Or • s .:tn r: 211 ION OF I31 NCi1i'1ARK I {11.1 -: t:`:C L: 1'0l 1 15" Le.,!, "t i,t -tire ennfurni !(1 suhn.irt• nr I. V cord nc■ 11s :ble rr tat Ltbl. - lot area exclh,,i,;e areas and prepared road beds st ill prrt•!tt. zi .t,s it-uay •,r.me:r'', • r,i r ,elusive of streams, lakes” +et t +rs!it tc.: ditcrids. rnai the, p• _. :i z �rl� ( .uncle: t:. P. 2, (non- residential), t _ c d :it . c ar a and ti. titer a'apply r r ;j : r ,t', «,: w ater 1 h rnup.t be denied air.. i.h -r❑ 'cct c�ilu iz5r� , tax DTI'11i 01 1=.XCAVA T l(t:N' It appiicable recr; depth ofet(eavatirin leg need Record NA" It nst appEtca'h;r parcel number) . ':iiuCI r (TmsIheat u,hstructcd art:(t art:( must mt.'t 1 elet ation Record the t he rccortted ,1 lot r t,c „ ,re :et il`ed t flot rI::;ta _n lur 1.c.+ t .iar - ;eOtt: 11 (1I e c rusal are required_ Soil 11 +olor. ;:nor , ,tt -� sail texa,;cs). IZ fusala l!: _ he .cries be '- 1 !I. •(1 4 " ,: rt, r t.r hell a"r ept,•,rent' as sit uxt, 11,51).tt rant reaps, st :_lat. it Pratt:at i :r(c if molding to present ,'heck drainfield cunft<u(tratittn required. if :alter, ;1 =cerl, type Record any additional remarks pertinent to site or installation I x< dosing require : 5 nature of edrlluatir title and date of eva1■34a'r: Pr engineers mils, ;:0 all dacurr,ents submitted. PROPERTY ADDRE1SS: LOT: T [t" SYSTEM DESIGN_ - A [ N [ R [ 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Z DH 4016, 12/99 (Page STATE OF FLORIDA DEPARTMENT OF HEALT ONSITE SEWAGE TREATH CONSTRUCTION PERMIT CONSTRUCTION PERMIT FORD [Iv] New System [ Existing System [ Holding Tank y Repair [ Abandonment [ Temporary APPLICANT: L ' x'11 ` 2 Q ..� N 4k., CX1 D rJ S 5 BLOCK: PROPERTY ID #: Y - .1-1 —00 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S.; AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY 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. • 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 DEVELOPMENT OF THIS PROPERTY. GALLONS / GPD GALLONS / GPD GALLONS GREASE INTERCEPTOR CAPACITY GALLONS DOSING TANK CAPACITY [ D ( SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: ['] STANARD [ FILLED I CONFIGURATION: ] TRENCH [ BED [ N _ F LOCATION OF BENCHMARK: 41 ICJ \ ry - �� '�1 l`� A I ELEVATION OF PROPOSED SYSTEM SITE [ot+' ] (I S /1I [ABOVE/ E BOTTOM OF DRAINFIELD TO BE [41.2 -] (f CH /FT] [ABOVE/ ICATIO D FILL REQUIRED: ( -Jf -] INCHES c-J EXCAVATION REQUIRED: [ ] INCHES INCTALL 99® OF LC) MY COARSE SAND UNDFR ROTTOM OF DPA NFrILD SIIRMIT RENCHMAAK BEFOP ION THIS PERMIT IS NOT FOi -t ALA) i iOi4(3) INVERT ELL:VA i + • . SOT OM 01- t1 ,NlELD ELCfA 1 ' SUBDIVISION: Ott' 2: e AND DISPOSAL SYSTEM TITLE: Used) e p MD 8 SDll PD pt. 3: Installer/Contractor pt. 4: Building Department PERMIT NO. 01- DATE PAID: A_ 2_ c7 FEE PAID: RECEIPT #: 0/ 02.01.x07 13 _ O 7 .�5' TITLE: g C 7c • �W L AJ/ Innovative • [SECTION, 'TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] EROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] GALLONS ® [ ] DOSES PER 24 HRS # PUMPS [ ] MOUND [ BENCHMARK /REFERENCE POINT BENCHMARK /REFERENCE POINT EXPIRATION DATE: a G Page 1 of 3 CHD INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. CONSTRUCTION PERMIT 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. (CHD may require property appraiser ID # or section /township /range/parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter64E -6, FAC. DRAINFIELD: Minimum specifications from Chapter 64E-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 (CHD) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CHD 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. - STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITESEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PAR T II SITE PLAN -.. Scale: Each block represents 5 feet and 1 inch = 50 feet. 1 1 1 1 .) T k- 1 � .., I 1 1 I 1 -ri J �_1JJJ J 1 C� ( _ I. 1 I I l l l l l l II i U i 1 �i 111_ }�11/ Li I I I [ I _ 1 1 1 1 1 t 11 1 ' 1`l 1,3 1 i f { 1 �_I ;_111 ? !2121 1 _,1._) I 11 _ ! 1 1 1 i �II:I L JJ _ I . I 1 7 _ 1 7 C 1 I I 1 7 _ I _I. 1 11 1 1 # ! I_1 1 1' 1 1 1 , -1 I - -I_U L1 J _, �_IJt C' I_L '_I 11 l -1 _ I _ 1 _ �j I 1 _I_U 1J 1_ I�_! 1_C 1 I_I _ i • _I_f 1 1JJ - 1 I I' i tl 1 C I1_l ' i _ I _I.i_!_I 1_1! I_ ! • L1 1 _ hO U I_ ' I (� 1_ } -1 Cl, L i I C -1_FJ 1 i= 1 _ — I�, 1 1 I r a+ LI � *j , iJ 1 i i J 1 - _ 1 1 7 1 .. 1_ I ! I1 ( 17 , 1 J �l Notes: A' s , S $ By Gneti,}3P1 0.- G\ Site Plan submitted by Plan Approved 3 sW - -1 MIA 33133 oferz_f otiJi. Signature Not Approved ALL CHA GES MUST BE APPROVED,'BY THE COUNTY HEALTH DEPARTMENT DH 4015. 10/96 (Replaces HRS-H Form 4015 which may be used) (Stock Number: 5744. 002 - 4015.6) Title Date' County Health Department 1U I:1 1 _I. 1 I 1_S 1 1 L L I i 1_h 7 11 _1_1 1 _ __i - l 1. _121_, I '_I_ t 1 1_1 1 I_ IJT 1 1 _1- U 1 i 1 1 1( L.!ftUl_ 1 J J _L _ 1_ 1, I I i ', : . ( 1 r i ,7_ _' 1 A I 1 1 1 I 111 7 11111 f r1. t l'-"" J _r. I ! —:J I7 " -L I I Page 2 of 3 BUILDING ELECTRICAL PLUMBING ROOFING Owner of Building Architect Contractor or Builder Legal Lot Description MIAMI SHORES VILLAGE, FLORIDA ❑ PERMIT N° 14327 Subdi- vision (_l DATE /1 2 ❑ Work to be performed under this Permit 195 Contractor's License No Address of r Value of Amt. of . Building 1 "� 'L � '% 1.) • '" C . ~ J . -«s,, Project $ Permit $ -: This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or .in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. Signed, P.J \ . i� 'rt-;. 4 ...+ BY ( .'' ..� _. 1, " "' INSPEc4OR 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, statemen< or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume res onsibility for all work done by either, myself, my agent, servant or employee. 1 ( - `' - .. L 1..--1... am / CON O R / BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMBNG ROOFING Owner of Building Architect Contractor or Builder Legal Lot Description. Address of Building PERMIT IN? 12544 f] Work to be performed under this Permit CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Bl. Subdi- vision Value of Project $ DATF Contractor's License No 1 4 Amt. of Permit .i • 195 war This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. . Signed j- - BY INSPECr9R 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, servant or employee. BY AUTHORITY Permit No 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. Feet of Drain Tile STATE OF FLORIDA, COUNTY OF DADE. Owner's Name and Address-___ . _&t2 - __ Registered Architect and /or Engineer. Employing Plumber's Name Location and Legal Description Lot -, ` �il.52A MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEN's' APPLICATION FOR PLUMBING . "' ;LA OT Street and Number where work is to be performed —No. ...t.e > Block_ State work to be performed and purpose of building (By Floors) New Building _ -- Remodeling -- Size Septic Tank Type of Tank Capacity Gals Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $ .e/__- ___-------------- - - - - -- — -- (Signed) - No- _ 12.3 Street-._ Wg 9? Street - Subdivision._f - . Street_- /=A jf 0 Addition________._._.___ _.__._ Repairs No. of Stories Plumbing Inspector. 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 Worlanen'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 tiie 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. (Signed)._ Date My Corrunission Expires Notary Public, State of Florida ,6. 30 ,/ �'Y'���'s��z 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. 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 URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•NS TOTAL FIXTURES CONTR. LIST a. / / 3 Q! �- -- CHECK . SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP Sosofee HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST / - - -- CHECK Permit No 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. Feet of Drain Tile STATE OF FLORIDA, COUNTY OF DADE. Owner's Name and Address-___ . _&t2 - __ Registered Architect and /or Engineer. Employing Plumber's Name Location and Legal Description Lot -, ` �il.52A MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMEN's' APPLICATION FOR PLUMBING . "' ;LA OT Street and Number where work is to be performed —No. ...t.e > Block_ State work to be performed and purpose of building (By Floors) New Building _ -- Remodeling -- Size Septic Tank Type of Tank Capacity Gals Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well Size of Soakage Pit Amount of Permit $ .e/__- ___-------------- - - - - -- — -- (Signed) - No- _ 12.3 Street-._ Wg 9? Street - Subdivision._f - . Street_- /=A jf 0 Addition________._._.___ _.__._ Repairs No. of Stories Plumbing Inspector. 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 Worlanen'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 tiie 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. (Signed)._ Date My Corrunission Expires Notary Public, State of Florida ,6. 30 ,/ �'Y'���'s��z 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. 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 / r I 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 Vi11 e, 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 Buildin Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be`ks. at building during progress of work. l . �v Owner's Name and Address Registered Architect and /or Engineer qr r _ / Employing Plumber's Name L'2 ` C-s? �'-e '«``t^.�{, t 1 '' No. L_S 3 4 Street_ 611 7 Location and Legal Description L lock � Subdivision Street and Number where work is to be performed —No L ________A'r X , Street 9' 3iI-"e LC-'r State work to be performed and purpose of building (By Floors) uildd ng Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank____ Capacity Gals Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply ity 1We11 F oD ______ of Soakage Pit STATE OF FLORIDA, COUNTY OF DADE. ss. My Commission Expires Amount of Permit $ :2 (Signed) (Signed) Plumbing Inspector. 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 tinder 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. Notary Public, State of Florida Master Plumber. 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 URINALS CATCH BASIN FLOOR DRAIN DRINKING FOU NT' NS Nt.T Q / I! �U�c I� Pl /2. TOTAL FIXTURES CONTR. LIST / /, /� CHECK . S' /I J ? S I / 3 L) 7 J ✓ / f y f� / { ] SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP MR A HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL �� CONTR. LIST -_ i# ()(: / CHECK SO Permit No. ,MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT • Date / r I 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 Vi11 e, 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 Buildin Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be`ks. at building during progress of work. l . �v Owner's Name and Address Registered Architect and /or Engineer qr r _ / Employing Plumber's Name L'2 ` C-s? �'-e '«``t^.�{, t 1 '' No. L_S 3 4 Street_ 611 7 Location and Legal Description L lock � Subdivision Street and Number where work is to be performed —No L ________A'r X , Street 9' 3iI-"e LC-'r State work to be performed and purpose of building (By Floors) uildd ng Remodeling Addition Repairs No. of Stories Size Septic Tank Type of Tank____ Capacity Gals Feet of Drain Tile __Dist. Feet of Tank or Drain Field from Well Nature of Water Supply ity 1We11 F oD ______ of Soakage Pit STATE OF FLORIDA, COUNTY OF DADE. ss. My Commission Expires Amount of Permit $ :2 (Signed) (Signed) Plumbing Inspector. 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 tinder 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. Notary Public, State of Florida Master Plumber. 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 APPLICATION FOR MIAMI SHORES VILLAGE Date 2 5 0 Job Address 123s Ne 3 ST Tax Folio it' 3205 02 0 04 -0 Legal Description to 4 5 ll b (JCIVj LwvC, Historically Designated: Yes No Owner/Lessee / Tenant Man S iym T n \J Owner's Address 235 gE c71 3 S S io(°S 3o` t Contracting Co. SecAC COV) rNQ C-k Q r) g i fl C Address (AP 0 g 1 Ar,x, $ Z 3 M I Aorvtl 3 3 Qualifier TeX eSc ("'' k °CY\wn SS# , � Phone 0606G1-6-63.3 State # 3 1 )\ - oci �v a 8 Municipal # Competency # Address Architect/Engineer N Bonding Company ki t\ WORK DESCRIPTION 6 Signature of owner and/or Condo President Date Notary M Co • xp =c >° J. SOLOMON MY = 6M ISSION # CC 854606 ` EXPIRES: Jul le, 2003 i NOTARY NMI/ tunics & Bonding Co. FEES: PERMIT � RADON Irb4, L14 ' Date Zoning Building Mechanical Plumbing Address Master Permit # Phone (:) 1S4- - ! SS Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL IKUMBI*G MECHANICAL ROOFING PAVING FENCE SIGN 1 nskcAk 1 C sfev Square Ft. , 0 0 Estimated Cost (value) At 9 500 23 Ins. Co. ti au fit 0 t 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 AN 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 ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 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. Furthermore, I authorize the above -named contractor to do the work stated. Date as to on My Commission c '. + i III' - Q �r (:) MY COMMISSION EXPIRES F OF F■ NOV. 15,2002 ate C.C.F. ! D NOTARY S. o 0 BOND' d , APPROVED: TOTAL DUE 3 / Electrical Structural Engineer AR SEAL �PA BECKER COPMBSS1ON NUMBER CC786697 APPLICANT: f� Tfr AGENT: ^ ,p( A f� S�P�f l G C�7r� C t 4� LOT: ct S BLOCK: SUBDIVISION: BosAl LIAR e PROPERTY ID #: O21 -00'-0 TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [ ] YES (L4 NO NET USABLE AREA AVAILABLE: . ACRES TOTAL ESTIMATED SEWAGE FLOW: 200 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2) AUTHORIZED SEWAGE FLOW: (0 0O GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: 4-Q0 SQFT UNOBSTRUCTED AREA REQUIRED: 100 SQFT I BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS 2.G [INCHES / [ABOVE /T!!!!] BENCHMARK /REF NC `PyINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: N FT DITCHES /SWALES: N A FT NORMALLY WET? [ ] YES [ WELLS: PUBLIC: N A FT LIMITED USE: N A FT PRIVATE: NA FT NON - POTABLE: N i FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: In FT POTABLE WATER LINES: 1C) FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES pl NO 10 YEAR FLOODING? [ ] YES [s.(NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: 5.1 FT MSL /NGVD W.T. 3.o SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture Death l0 \IR+s'1 e)(6 L0\( S ) C 11 too ?, II to to to to to to to to USDA SOIL SERIES: �� () OBSERVED WATER TABLE: KI R. INCHES [ABOVE / LO ] EXISTING GRADE. TYPE: PERCHED / A T] ESTIMATED WET SEASON WATER TABLE ELEVATIOy: 32.4 INCHES [ ABOVE / BELO• ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [ANO MOTTLING: [ ] YES [0140 DEPTH: INlA INCHES SOIL TEXTURE /LOAD'ING RATE FOR SYSTEM SIZING: ). O DEPTH OF EXCAVATION: (8 INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [L/']' BED [ ] OTHER (SPECIFY) `'' REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BIY: DH 4015, 10/96 (Replaces HRS- (Stock Number: 5744- 003 - 4015 -1) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS i 15 [Page 3] w ay be used) [Section /Township /Range /Parcel No. or Tax ID Number] F e 3' 1235 N(5 73 ST 33138 PERMIT # c SOIL PROFILE INFORMATION SITE 2 Munsell , Color Texture Depth I , R°� ► to �l S4149 DI to 12 I to USDA SOIL SERIES:U, to to to to to to to DATE: ��Ib1 Page 3 of 3 IN'IlTRUCTIONS PI RMI"i' Nt N11;1 f l' rmit tracking number by t;nun health Pep..rtnKrit. AII'Lit':A 'I 1 ri, e r:. rna TIC! s tr it flame AC,1•.N 1 1..0I., III .tK is s( ;lii)tdltiit)N , tnd z n d lstr�n !nr lot PROPI • RTC" Iit VI` ?tt31 R h.!'xi...!el numh;l I )f prop:recta, (pr PROM..RP. stih SL4) ; i i.t))1; • UNt)liS ! Rl.t.' 1; B}• I1 \ -rth ! ^ :l 1 if > 'ti1t i'1 ' s' `, I'kt;ilt 1, i:;tt?R\. /, r1'7'. 1 .\AI1 -14 /• \!1 DRAINFiI 1.1) CON'FI( CI;iti ADDITIONAL (RITERiA: SLID I'.VALL A i'Itl) 3Y L:L.t ?VAIION WORK SIIL)� "T BENCHMARK ( '+ SL147r H.I. t'rtater :F toant.r • itt - ali4 altthnr1Lrd ten +, -CO euage 1111 V fur do: •st:. :.s i t" i A Record the at t 1lr:r , per : , per der: (Gt. pr 'i :1' u! :t;;gr !t■' 60C' 101,1 , 1 •> , run' t!t ura.r.rst:ttu.t..1 u, the r:.inli.:lt: .1 rt.ecrel [':_ Ia n'. nth: 1•.'1_ltnrnrk ti!r n ;■i it ,•..d)hc n!nrrrc;ti,c t snit ptofilet :vithin the prop: .1st 1 • idr will it;er I.IS1)A Soil ( r•,. ., rout he ele:rl} ;L-_t.r..crited Pro ei t :. 1c-t. rro fed Pei —.. led the der•ih .11 the observed eater thie epptaptiatr. Rcettrd the estrrrtated uet ,ea ts) v,at r r:t!• meal ittstnrr ;al information i;tdic•)t' there i Ind :let „ li S()11 "'1E.% I 1 10i: !2etotd soil tcatur_ or loadin;i rate Or • s .:tn r: 211 ION OF I31 NCi1i'1ARK I {11.1 -: t:`:C L: 1'0l 1 15" Le.,!, "t i,t -tire ennfurni !(1 suhn.irt• nr I. V cord nc■ 11s :ble rr tat Ltbl. - lot area exclh,,i,;e areas and prepared road beds st ill prrt•!tt. zi .t,s it-uay •,r.me:r'', • r,i r ,elusive of streams, lakes” +et t +rs!it tc.: ditcrids. rnai the, p• _. :i z �rl� ( .uncle: t:. P. 2, (non- residential), t _ c d :it . c ar a and ti. titer a'apply r r ;j : r ,t', «,: w ater 1 h rnup.t be denied air.. i.h -r❑ 'cct c�ilu iz5r� , tax DTI'11i 01 1=.XCAVA T l(t:N' It appiicable recr; depth ofet(eavatirin leg need Record NA" It nst appEtca'h;r parcel number) . ':iiuCI r (TmsIheat u,hstructcd art:(t art:( must mt.'t 1 elet ation Record the t he rccortted ,1 lot r t,c „ ,re :et il`ed t flot rI::;ta _n lur 1.c.+ t .iar - ;eOtt: 11 (1I e c rusal are required_ Soil 11 +olor. ;:nor , ,tt -� sail texa,;cs). IZ fusala l!: _ he .cries be '- 1 !I. •(1 4 " ,: rt, r t.r hell a"r ept,•,rent' as sit uxt, 11,51).tt rant reaps, st :_lat. it Pratt:at i :r(c if molding to present ,'heck drainfield cunft<u(tratittn required. if :alter, ;1 =cerl, type Record any additional remarks pertinent to site or installation I x< dosing require : 5 nature of edrlluatir title and date of eva1■34a'r: Pr engineers mils, ;:0 all dacurr,ents submitted. PROPERTY ADDRE1SS: LOT: T [t" SYSTEM DESIGN_ - A [ N [ R [ 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: Z DH 4016, 12/99 (Page STATE OF FLORIDA DEPARTMENT OF HEALT ONSITE SEWAGE TREATH CONSTRUCTION PERMIT CONSTRUCTION PERMIT FORD [Iv] New System [ Existing System [ Holding Tank y Repair [ Abandonment [ Temporary APPLICANT: L ' x'11 ` 2 Q ..� N 4k., CX1 D rJ S 5 BLOCK: PROPERTY ID #: Y - .1-1 —00 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S.; AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY 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. • 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 DEVELOPMENT OF THIS PROPERTY. GALLONS / GPD GALLONS / GPD GALLONS GREASE INTERCEPTOR CAPACITY GALLONS DOSING TANK CAPACITY [ D ( SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: ['] STANARD [ FILLED I CONFIGURATION: ] TRENCH [ BED [ N _ F LOCATION OF BENCHMARK: 41 ICJ \ ry - �� '�1 l`� A I ELEVATION OF PROPOSED SYSTEM SITE [ot+' ] (I S /1I [ABOVE/ E BOTTOM OF DRAINFIELD TO BE [41.2 -] (f CH /FT] [ABOVE/ ICATIO D FILL REQUIRED: ( -Jf -] INCHES c-J EXCAVATION REQUIRED: [ ] INCHES INCTALL 99® OF LC) MY COARSE SAND UNDFR ROTTOM OF DPA NFrILD SIIRMIT RENCHMAAK BEFOP ION THIS PERMIT IS NOT FOi -t ALA) i iOi4(3) INVERT ELL:VA i + • . SOT OM 01- t1 ,NlELD ELCfA 1 ' SUBDIVISION: Ott' 2: e AND DISPOSAL SYSTEM TITLE: Used) e p MD 8 SDll PD pt. 3: Installer/Contractor pt. 4: Building Department PERMIT NO. 01- DATE PAID: A_ 2_ c7 FEE PAID: RECEIPT #: 0/ 02.01.x07 13 _ O 7 .�5' TITLE: g C 7c • �W L AJ/ Innovative • [SECTION, 'TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] EROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] CAPACITY MULTI- CHAMBERED /IN- SERIES [ ] [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] GALLONS ® [ ] DOSES PER 24 HRS # PUMPS [ ] MOUND [ BENCHMARK /REFERENCE POINT BENCHMARK /REFERENCE POINT EXPIRATION DATE: a G Page 1 of 3 CHD INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. CONSTRUCTION PERMIT 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. (CHD may require property appraiser ID # or section /township /range/parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter64E -6, FAC. DRAINFIELD: Minimum specifications from Chapter 64E-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 (CHD) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CHD 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. By APPLICATION FOR ONSITESEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II SITE PLAN Scale: Each block represents .5 feet and 1 inch = 50 feet. crt 1 - 1 - - re - 4 s ( - 1 - 1 - y - s - 1 - rn - 1 1,1i ; 1 11 J1 j_l _ _ ii,11•1•11Ditit ins r 1,3 • 1:1 1 1 1 1 1 1 - :1 1 • I t est- - ; si; ;11 _1 _ICC ; 1 ; ' 1 ; # i 1 _ 111r111 1 • I 1- 1 ss s _s s u t 11 1 u 1 'sa s _i_u 1_1 1 -- I I 1 •srs i s I i 1 1 • • J_J LI ' I 1 Lu • 1 i _ J Lt 1 0 L 1 1 s , • 1 • LLLELi_ _ 1 1 1 t „ . •1 ' ^ 1 t 0„,„ Notes: (Sk k , ::1'1 1 1:42 a. Siat fik. okierz-c- [NG. LL JCjt ss i u " I Site Plan submitted by Plan Approved ALL CHA z 'I st \ *ok.- • , • DH 4015. 10/96 (Reblaces HRS-H Form 4015 which may be used) (Stock Number: 5744-002-4015-6) Signature Not Approved - STATE OF FLORIDA DEPARTMENT OF HEALTH 1, __ - Cr - Lo 1 # - 1 1-1 11 I 0 _J1 I i_L_LICI i ; i j , u J - ; - Cji - i - IT 1 s j__ i__I1___C_C I _ - - st_iLitili .."'sJ 1_ ..... - iLiTi-1:11--_-r-D7. ss I __II Llutitt - t --- 1 II' iji 1 1 — t — ..„ I IITI'I - 17 _ i 1 ! s" L --. _L, ,s i_c_iLt I ;_t_s___L•" • ' 1. t :3 :...Irf.c.I 1 .7). - _1:0_j+1..J..__Lt._ 1.__L.TL, I 1 - 1 1,_j 1_.# _j_1 1 Lij_i_112 LI ...1_C 1._.) 1. 1 1 1_ 1 _1_ ) ' 1 U 1 ; J 33133 GE S11UST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Title Date' If County Health Department r • . Page 2 of 3 , !