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1275 NE 93 St (5)Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for4e 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 lof 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 ..... __ �__�_ — __---------- -- .____. Employing Plumber's Name_49Q.W, ,1/L L2 p � -, e CG No _ Street__4-../ G Location and Legal Description Lot._______ — _.__— __________ _ Block Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building_._.._ .... Remodeling Size Septic Tank _ Type of Tank__ Capacity Gals Feet of Drain Tile. Nature of Water Supply: City —Well. Amount of Permit Z A D No - 7 5 — _ Street- Xi:— / 3 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 wilt 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 �gt'e licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r "' a*M T Addition Dist. Feet of Tank or Drain Field from Well .Size of Soakage Pit (Signed) t' mbing Inspector. Date Subdivision Street Repairs No. of Stories _ aster 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. Notary Public, State of Florida My Commission Expires NOTE: A re- inspection fee of $1.00Iwill 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 TUNS iNAf URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST I CHECK 1 — SEPTIC TANK SEWER CONN. DRAIN SOAKAGE FIELD PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM•G POOL Co. NTR LI ST yri/L/7 CHECK Permit No Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for4e 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 lof 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 ..... __ �__�_ — __---------- -- .____. Employing Plumber's Name_49Q.W, ,1/L L2 p � -, e CG No _ Street__4-../ G Location and Legal Description Lot._______ — _.__— __________ _ Block Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) New Building_._.._ .... Remodeling Size Septic Tank _ Type of Tank__ Capacity Gals Feet of Drain Tile. Nature of Water Supply: City —Well. Amount of Permit Z A D No - 7 5 — _ Street- Xi:— / 3 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 wilt 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 �gt'e licensed by Miami Shores Village. STATE OF FLORIDA, 1 COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r "' a*M T Addition Dist. Feet of Tank or Drain Field from Well .Size of Soakage Pit (Signed) t' mbing Inspector. Date Subdivision Street Repairs No. of Stories _ aster 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. Notary Public, State of Florida My Commission Expires NOTE: A re- inspection fee of $1.00Iwill be made when such re- inspection is made •necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No. i '5/ Date. - - ! - - 2 ._ l.-7 ,.3 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. j ` / Owner's Name and Address__ 5141,/a c _ '4-L $ No.---- _--- _ - - - - -• -- .-- - - - - -_ Street. Registered Architect and /or En ineer /----- �_ — -- ----------------_-- Employing Plumber's Name__ -- _L te..A 5,,b . 0 22tAarifte No.- - - - -__ — Street__ Location and Legal Description Lot.--_.___ AO Block_ / Subdivist Street and Number where work is to be performed —No 1,2,73A/1 ....7" 5 State work to be performed and purpose of building (By Floors)----_------.--_--------__-_-- New Building — Remodeling____ _____ —__ Addition.___ Repairs No. of Stories. _ Size Septic Tank — 0 . Q ..____ --- --; Feet of Drain Tile._ 25, I 4 Nature of Water Supply: City — Well.______ Amount of Permit $___ STATE OF FLORIDA, COUNTY OF DADE. j 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 Compensatio Act, being Section 5986, 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 sit of the •r! such pub ' otice or notices as are required by tlie Act. The undersigned agrees to employ only such sub- contractor., on work to b perfo er this permit, as are licensed by Miami Shores Village. Before me, the undersig '�d authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and o, being by me fast duly sworn, upon oath deposes and says that he is the__ of the above describ' construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated • e true. My Commission Expires NOTE: 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 worlcmanship. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank — _��,_L (Signed)._ (Signed Capacity Gals Street Feet of Tank or Drain Field from Well Size of Soakage Pit Notary Public, State of Florida Master Plumber. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS U RINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' N6 TOTAL FIXTURES CONTR. LIST I CHICK I SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST CHECK Permit No. i '5/ Date. - - ! - - 2 ._ l.-7 ,.3 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. j ` / Owner's Name and Address__ 5141,/a c _ '4-L $ No.---- _--- _ - - - - -• -- .-- - - - - -_ Street. Registered Architect and /or En ineer /----- �_ — -- ----------------_-- Employing Plumber's Name__ -- _L te..A 5,,b . 0 22tAarifte No.- - - - -__ — Street__ Location and Legal Description Lot.--_.___ AO Block_ / Subdivist Street and Number where work is to be performed —No 1,2,73A/1 ....7" 5 State work to be performed and purpose of building (By Floors)----_------.--_--------__-_-- New Building — Remodeling____ _____ —__ Addition.___ Repairs No. of Stories. _ Size Septic Tank — 0 . Q ..____ --- --; Feet of Drain Tile._ 25, I 4 Nature of Water Supply: City — Well.______ Amount of Permit $___ STATE OF FLORIDA, COUNTY OF DADE. j 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 Compensatio Act, being Section 5986, 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 sit of the •r! such pub ' otice or notices as are required by tlie Act. The undersigned agrees to employ only such sub- contractor., on work to b perfo er this permit, as are licensed by Miami Shores Village. Before me, the undersig '�d authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and o, being by me fast duly sworn, upon oath deposes and says that he is the__ of the above describ' construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated • e true. My Commission Expires NOTE: 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 worlcmanship. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Type of Tank — _��,_L (Signed)._ (Signed Capacity Gals Street Feet of Tank or Drain Field from Well Size of Soakage Pit Notary Public, State of Florida Master Plumber. DADE TESTING LABORATORY INSPECTING ENGINEERS & CHEMISTS 49B5 E. 10TH LANE H I A L E A H, FLORIDA PHONE MU B -4412 Dade COr 7`1cr , .,ar• County vaul o�o - iam9. cor Sirs; The Dade Tooting Laboratory has been rotalnod to do the pile drivin3 inspec:Lion by the Atlantic :'c radation C6., For the Arco Construction Co. on the el to of 1275M.. 03rd r)treat, ' :gtmi Shores, Florida. ATC /lp :fit. 27th 1055 Pospoctftlly yours, bade Testing; Laborato ,I•y . A. T. Curtin, i ;r. Order No. 175 Lab. No. 1474 Job Location Contractor Pile Driving Contractor Pile Manufacturer Pile Inspection Piles Stamped 031 01. ea. 3. 0 03 ALL PILES 10' x 1O x 16w Continued on Sheet #1 REPORT OF PILE DRIVING INSPECTION " 1 4 4 15 TESTING LABORATORY NSPECTING ENGINEERS & CHEMISTS 4985 E. 10TH LAN E HIALEAH, FLORIDA PHONE MU 8-4412 For Arco Construction Coo 618 110E0 79h Street Miami Florida. House : 1275 U.E. 93rd Street, Miami Shores, Florida. : Arco Construction'Co. Atlantic Foundation Co. At/antic Precast Pile Co. Dade Testing Laboratory. D.T.L. Initials ft= 7 rt 9 ale Of) 1.71 ;41 16 -Z18 a 20 The structural Engineer (N.G. Stephan) Specified a 15 ton bearing for all piles, Ey the Engineering NeVTs Forauls; 3 Blows Per Inch (Avs.) 16.86 Tons., CM, September 29, 1955 boo 1 1 Sheet #2 Order N 175 Lab o No 0 1474 9/29/55 Vb ,!A va ✓ ., W ha M H+ in ,a+ The following table shows that all the piles were driven to 4 o a bearing greater than that which was required by the engineer 0 Pile No 0 Driven Length 1 2 3 5 6 a 9 10 11 12 13 14 15 16 17 . 18 29 20 DADE TESTING LABORATORY I NSPECTING ENGINEERS & CHEMISTS 4985 E. 10TH LANE Reinforced Concrete Piling of 3500 Vulcan #2 Pilo Haimer0 2o42 Stroke a 50000 raM. Inspection on September 28th, 1955 CC - 3 Client 1 Dade Bldg. DePt0 1 Miami Shores Pia 0 Dept. 1 Engineer H I A L E A H FLORIDA PHONE MU 8 -4412 17.a 14Q 12 12 13a 6m 12 6' 15a 12 129 14a 10a 12 13 127 6 sa 12 111 124 6" 13 12 6" 12o 5 psi @ 28 days 0 by William A. Lotzo k CCA A0 TO Curt1n Mgr® Avg. N00 Blows Per Last 5`a 5 5 5 5 4 5 4 5 5 5 5 5 5 6 5 4 5 Respectfullt sub2?tted DADE TESTING LABORATORY. 01 Order No0 175 Lab° NO0 1474 Job Location Contractor' Pile Driving Contractor Pile Manufacturer Pile Inspection Piles Stamped m A w Cla ALL PILES 10" x 10" x'16 I: Gi 8 " 14 Continued on Sheet `th DADE . TESTING LABORATORY INSPECTING ENGINEERS & CHEMISTS 49B5 E. 1OrH LANE H I A L E A H, FLORIDA PHONE MU 13-4412 REPORT OF PILE DRIVING INSPECTION 15 :lo - 20 The structural Engineer all piles0 By the Engineering News For Arco Construction C o c a 618 N0E0 79th Street Niami Florida ° Rouse 1275 U0E0 93rd Street. Miami Shores, Florida 0 Arco Construction Goo Atlantic Foundation Coo Atlantic Precast Pile 000 Dade Testing Laboratory° D0T0LO Initials D C7 10 16 5 Blow Per Inch (Avg°) a 16086 Tons° 60 0f C a September 29 1955 @L 7 11 18 (W 0C•0 Stephan) Speeif'ied a 15 ton bearing for Formula; Sheet #2 Order N 175 Lab. NOR 1474 9/29/55 Qi M m eV 4 Hi Yml �i.l N m a 44 au b Cc 4 Ca C? .a The following table slows that all the piles were driven to give a bearing greater than that which was required by the engineer° Pile No o Driven Length 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DADE TESTING LABORATORY INSPECTING ENGINEERS & CHEMISTS 4995 E. 10TH LANE H I A L E A H, FLORIDA PHONE MU 8 -4412 11 141 12 12 13 6 12 6" 131 12 12 14 10 120 13 121 6° 120 11 12 6 13 121 6" 12 Reinforced Concrete Piling of 3500 psi @ 28 days° Vulcan #2 Pile Hammer. 2042 Stroke, 3000# llama Inspection on September 28th 1955 by William A. Lotzo CC - 3 Client 1 Dade Bldg. Dept. 1 Miami Shores $idg o Dept o 1 Engineer 5 5 5 5 4 5 4 5 5 4 5 5 5 5 6 5 5 5 5 Respectfullt submittod DADE TESTING LABORATORY. Avg. No. Blows Per Last 5 CL1- ,` A © To Curtin Mgr o j A r Date: &t4' Notary as to Owner and /o My Commission Expires: FEES: PERMIT ✓�/` APPROVED: Zoning PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 127 Il/1 4 3 ST Tax Folio Legal Description Owner / Lessee / Tenant. L U UM/kJ L / Master Permit # 3 •i / Owner's Address X 12 75 , /(/6 9 3 St Phone g (42,44 ,Ate) 22 Contracting Co. Co — Address Qualifier SS# Phone ,25-01 (1 State #4emi310 Municipal i;f1 Competency # Ins.Co. LJ p-c� en.4a4.2 -f�- Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING Aid AL ROOFING PAVING FENCE SIGN WORK DESCRIPTION A /Lac/ ,vN. .ice( Square Pt. Y040 1 Estimated Cost(value 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 certifyithat all the foregoing information is accurate and that all work will be done in comp iance w th all applicable laws regulating construction and zoning. Furthermore, I authoriz= th :J d contractor to do the work stated Oo RADON esident Signature of Contractor or Owner- Builder Date: OTARY SEAL %BARBARA ANN FUOAZZI * COMMISSION NUMBER CC360191 1 1. * ^ � * MY CQ1MISSIQPi L XP. 4. OF PV`'' MAR 20199 0 C.C.F. /0 Fire Buildin Mechanical Plumbi 1104-0 s. P P. OFFICIAL NOTARY SEAL. S: <, BARBARA ANN FUGAZZJ * � * COMMISSION NUMBER ' 5 Q CC360191 OF F L � Q MN COMMISSION EAP* MAR. 29 1998 Notary as to Con My Commission Ex NOTARY TOTAL DUE 7 9 Other Electrical Engineering APPLICATION FOR: [ ] New System [ ] Repair APPLICANT: �lnn AGENT: LOT: PROPERTY ID #: PROPERTY SIZE: BLOCK: DIRECTIONS TO PROPERTY: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental [ ] Abandonment MAILING ADDRESS: N' n l 2_2_ TO BE COMPLETED BY APPLICANT APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] SUBDIVISION: ACRES [Sgft /$3560] PROPERTY WATER SUPPLY: [ ] PRIVATE [ ] PUBLIC PROPERTY STREET ADDRESS: 11775 /L S 4- fu e ci S+ /L 4--0 tl e 1 . AAA, BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 1 [ k]/ Garbage Grinders /Disposals [AA Ultra -low Volume Flush Toilets APPLICANT'S SIGNATURE: (/RESIDENTIAL No. of Bedrooms 4 [ ] Other(Specify) HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4015 -1) DATE OF SUBDIVISION: [Section /Township /Range /Parcel No.] ZONING: [ ] COMMERCIAL Building # Persons Area Sgft Served PERMIT # DATE PAID FEE PAID $ RECEIPT # TELEPHONE: 6 , 0•7 /9 Business Activity For Commercial Only [Spas /Hot Tubs [ /Floor /Equipment Drains [Other (Specify) DATE: 7 if (Y Page 1 of 3 INSTRUCTIONS: APPLICATION FOR: Check type of permit, if Other specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street, city, state and zip coda mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, r, copy of C e lot legal description or deed must be attached. DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books (month/day /year) or date lot oeginsliy recorded. Divicing an approved lot into two or more parcels for the purpose of conveying ownership stall be considered a subdivision of the lot. PROPERTY ID//: PROPERTY SIZE: NO. BEDROOMS: BUILDING AREA: 11 PERSONS: BUSINESS ACTIVITY: FIXTURES: SIGNATURE: ATTACHMENTS: 27 character number for property. (CPHU may require property appraiser M 0 or cection/townaltip /range /parcel number. ti Net usable area of property in acres (square footage divided by 43,560 equate feet) exclusive of all paved areas and prepay .Tend beds within public rights -of way or easements and exclusive of streams, lakes, normally wet drainage ditches, mazshee, oz other such bodies of water. Contiguous unpaved and noncompacted road rights -of -way and easement with no subsurface obstructions may be included in calculating lot area. - WATER SUPPLY: Check private or public. PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county. DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location. BUILDING INFORMATION: Check residential or commercial. TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter 10D-6, PAC. Examples: single family, single wide mobile home, restaurant, doctor's office. Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for occupants. Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage ahed, or open or fully screened patios or decks. Based on outside measurements for each story of structure. Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are assumed. For commercial applications only. List number of employees, shifts, and hours of operation, or other information required by Table II, Chapter 10D -6, FAC. Mark each listed fixture with number installed or "NA" if not applicable. Signature of applicant or agent. Date application one day submitted to the CPHU with appropriate fees and attachments. A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded easements, onsite sewage disposal system components are location, slope of property, any existing or proposed wells, drainage features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any Public well within 200 feet of lot. For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and othez features necessary to determine composition and quantity of wastewater. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. .■ ■■. 11111 . ■■.. ■■■■G.i '� O . ■i . ■ ■1 . ■ IU ■•i■. _...U � ' ■ ' ■■ ■■ N� ■■■■■ ............... �� To ■ ■ n ■n� ■ ■. ■n �■■■■■ ■■■■■■ ■■ n ■ • ■ • .: nom mu sign .i■■■ ■ minim : ' :: Ini ■ . EN SM ■ •' ■E::. Nam ■I ■■■ .::C i = Mann ■ �l *- -- ii_ _ ■ .■ ■'■NiiiNiii� ■N�i■■■■■ r m in■■ ■r ■ ■ ■ ■m ■�iamini■ _ - 1 ■ ■■■ ■■■ ■ • "' ■ . mma n II: M'Iii INIAN Si I I NSIN ■.■�■�i�i ■■■� �i■IO ■ ■■ ■ ■ ■ ■. ■■ �Ni ■ nano ■ ■ ■■ ■ ■ ES■■ ■E ; ■ ■ ■■ ■■■■■E .E■■ ■■■■■■ E■■■ ■■ ■. E ■.m!■ 1:11mMimmONMS ■■ ■ ■. ■ ■mo ■ ■ NN ■.S■■■ ■■■� ■■■ • ■ '�: i ■■ ONn ■ ■S ■■■. E■..■ ni:■■■ ■ . ■■ min■■. .mm ■..■■ ■.. mmaN'..■■i'■■NN M NINON EN IMO Vs ml IMMO illii II 5 ill 11/11 Immii il 11 1 111 mil 1111110111111 'gun n ng n 1 . i • ... ■■■■■■■ .� . ' n nnn '■ ■' ■ S 'L ' R ■.. �' a "�:sm ■■. ■um iii ■ g_ _ l..n : �■ ■ ■■ ■ ■WIT= mO■■■ n r m i ■ ■ ■ IN I i 11 ■ ■ En C■ ■. ■ .■��'■'� _ ■ ■■■■■■uu ■■ ■■ ■ ■ In us _ ii■ RIM � '�i i . ■■ �' i Mom �� UM ■ 3! ■� It n■ 1 1111111111 1 0,0 ■■ ■■ ■■■!H ■ ■ ■ i ■■ ■■■ ■ ■ I ?'■'w." ■ m ■■■■ ■ _�_ .r10 _ ■ ■ ■■■■■■ ■■ ■■ annum nommarftwit mow • ■■■■ r. ■ mu . .:_ M T ■. ■■■■■■ ■■■■ MUMS !■ rip i _■l1■ - ■■U!M ■! ■■■ ■ ■. n■ �i■ ■■ Inalaginnungong ■ ■■■■■■ ■■ ■ ■ ■C !■ ■ mmmilC .■■■■■ ■■ ■ S ■. ■ . ■ ■■ ■■■ . ■ ■■■ .Ii ■ u Ii ■ ■ '' � ' �i EBi ■■i■■■ ■ ■■ ■ r l immOMME iii iliMIMUMMIR ImmORIM mill. Nm ■ �i ■ ■ . ' C'■ ■ ::::m:: Mill ' m ■IE: ' MI m o e s4� �: ■■■■■. i= ■ ■ ■ n ■ ■■ - s ■■■■■■ ■ nnumi ■ gsw m i. aNNIM■° I ■■,■■■ 0 ■■■ Notes: - Site Plan submitted by: Plan Ap roved By HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744.002- 4015 -6) Not Approved TITLE Date Public Unit ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT Page 2 of 3 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. 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. (CPHU may require property appraiser ID # or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: w 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 Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. 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.