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137 NE 92 St (8), .+r +h ^';/v- �^o..'W- JW.{ f�trt.-....,- r- ..^.h,.�.epi "-'��'''�:�yiy'.^'. _- STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYS CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, CONSTRUCTION PERMIT FOR: l4 ] New System 04) Existing System 0.] Holding Tank 41 ]. Temporary /Experimental W] Repair kJ ] Abandonment ] Other(Specify) ALLICANT: U p 1 l n 4111 ij AGENT: ° PROPERTY STREET ADDRESS: d 3 q Pqrr z •� 9 4 C tc. LOT: q a 1 I BLOCK: u I �"8 SUBD IVIS ION : m i (�_WL i� v 4, PROPERTY ID. 1)t :^i e e� 2. O Q -0 0 3• T A N .K D R A I N F I E L D 0 T H E R 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. P SYSTEM DESIGN AND SPECIFICATIONS 0 5 1 0 j [GALLONS / GPD] TIC T K /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ) [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] [ ] GALLONS GREASE INTERCEPTOR CAPACITY [=S ® ) SQUARE [ ] SQUARE FEET TYPE SYSTEM: ] STANDARD CONFIGURATION: kf ] TRENCH LOCATION OF BENCHMARK: f}tAJDZZ ELEVATION OF PROPOSED SYSTEM SITE Yea 0 ] [ BOTTOM OF DRAINFIELD TO BE [ LL' ] [ It FILL REQUIRED: [A Ar] INCHES' SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: FEET PRIMARY DRAINFIELD SYSTEM DH 4016, 10/96 (Replaces HRS -H Form 4016 [page 1) w (Stock Number: 5744- 001 - 4016 -0) p1 ® [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] Q Ai SYSTEM FILLED BED I D S /FT] [ABOVE =E ��W] BENCHMARK /REFERENCE POINT ES /FT] [ABOVE/ BE ] BENCHMARK /REFERENCE POINT [ ] MOUND ] PERMIT # - 4 DATE PAID .q -. a . _ ® � . FEE PAID $ 7i . 0 RECEIPT 0.5) ®.a 2.319 FAC EXCAVATION REQUIRED: [a° ] INCHES O .utJL L J �U D IJ UU OF I��dl (;Jt LI!) WINO QC; B t:9M5d® EtEUA4@ © 1 .I/,O QV LW 2.0 F WIDER G @ LMEO SI Iaa VHE TITLE: PiPio ° 0° .o MISOAFTOM DE OW g MEM 1111 gEROD YAM 8NALL LE PUMPED AOC)o .A S ma a OOa D [ OaSITAI D SOLE oa ��� eVaETf FEE Applicant 9 EXPIRATION DATE--/ , CHD Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health DepaY;?neftt. 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 10D -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. a: • ., 0 • •dpi .° • . • . ve s PROPERTY ID #: 11- SITE EVALUATED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS Dows ) LOT: PROPERTY SIZE CONFORMS TO SITE PLAN: [P%] TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: Munsell #/C for Texture Depth F// 4�� 9/.0A (J1 �0� to r a ?AM to ' USDA SOIL SERIES: 5 / to _\q� !/ pp ,. r` -J s "tO s % y .� tO /7. o J.. f/%_' t ` rf '1 /PAAl it )1, OBSERVED WATER TABLE: 0 INCHES [ABOVE / EXISTING GRADE. TYPE: ESTIMATED WET SEASON WATER TABLE ELEVATION: (, INCHES [ ABOVE / HIGH WATER TABLE VEGETATION: [ ] YES [O'NO MOTTLING: [ ] YES [ 112 11./7, -r DH 4015, 10196 (Replaces HRS -H Form 4015 )Page 3] which may be us d) (Stock Number: 5744- 003 - 4015 -1) ✓ AGENT: PERMIT/ 00 12-0(t- 8) BLOCK: SUBDIVISION: I c [Section /Township /Range /Parcel No. or Tax ID Number] 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. YES [ ] NO NET USABLE AREA AVAILABLE: ®rg'Y ACRES GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER-TABLE 2] GALLONS PER DAY [1500 GPD /ACRE 0 SQFT UNOBSTRUCTED AREA REQUIRED: { - SQFT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS /,5' [INCHES T] [ABOVE/gELOWWENCHMAIRRTKEFERENCE POIT' THE MINIMUM SETBAC WHICH CAN BE MAINTAINED FROM THE PRO OSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: j+F�+ FT DITCHES /SWALES: RM4 FT NORMALLY WET? [ ] YES [ ] NO WELLS: PUBLIC: ,, 1, FT LIMITED USE: A/ la. FT PRIVATE: yu /P FT NON - POTABLE: 0/4)- FT BUILDING FOUNDATIO S: FT PROPERTY LINES: S FT POTABLE WATER LINES: ]O FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [( NO 10 YEAR FLOOD G? [ ] YES [ NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: L �) FT MSL /NGVD S�PfiI� 4e® SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2 • Munsell C • ii•1 v for Texture S Depth 0" to to to to /G / to n to WO USDA SOIL SERIES: f// j, 4 CITE AP1 EXISTING GRADE. DEPTH: 4/4- INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: 0 INCHES DRAINFIELD CONF)GURATION: [ ] TRENCH N,] [ ] OTHER (SPECIFY) REMARKS /ADDIT P(NAL CRITERIA: / c�C_ �P;. ej ✓ ' DATE: j 0 0 0 Page 3 of 3 • N: rmit tracl.ing number by Cou; Health Department. .t, iAN,. Property owner's full name. ov. aut'oi.cti representative. .; • ,',;—••■,. ' su" - Ht. ; " •.;.,.`;;-:•-" :2/ ev. .ct 1.;m:lOur for .y ;o:operty appraiser :H.: m'oer or suction/township/,..,m,:c/pa: site — ,ccur( area o•F .•, ;Cs public o ur.sc iv v.rct i t. )ilier such r1. s • . • ;.: • I ;rus;,....cice) w :,;;; . :2 sewage f:1);.;.• Cot: lot wi nut ;,:km Lud. supi)ly • Y„ . water supplit: 2500 per acre for - 1 1...;;;'.:; dol::; • or c;.;ce.:Cithc the ; ;'::;:ca of ( in ;.":1...;;; ['CI! unobstructod are.. must bc eontiguo: •: OuTIC (above Ili tl seLbac!. •i• • •;,' to all listcd 0 :torus. . (1! sitc plat 0ut .1' the appl':;;;•c; lot iiust. • locatim •,21.12,;.ic '.-]:in 700 fect ufl h)t a"so ' • lot:; ct r.dh0 . ...:cord f)od • ...II: : • ai•LE11.) tyf - 6 feet t;. arc (,.•c..!;;'i co or.; and Ll! - Icarsals - •;;: 7 7. Soil SrieS 1 • ;k:COYC "\JN:.( •;21:,, ; cannot b ;;.t 0 !,` • ; Zuco, I:. I• 1 • I ..•;c1 .; . .;:o cor..... so'. or lo.....11ofz ao; s);storri o"..C%.C.L AVC1 " .;d. . othec, co:. ;;t;y H.,. of c. ;oust se.;.1::" / 1 r I SHaT .11 tp or illSt ".173 2 S07 SITE H.l. ] Notes: By Scale: Each block represents 5 feet and 1 inch = 50 feet. �.ea. 400 Site Plan submitted by: Plan Approved 1 DH 4015, 10/96 (Replaoos HRS-H Form 4015 which ma be used) (Stock Number: 5744 -00¢- 4015.6) STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION'PERMIf r)( Permit Application Number ' (Xi) L /) PART II - SITE PLAN- ISO &L Toq 4)"- terzsirlitti ALL CHANG MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 7;t i - ► I ! LEA Tut. To Vy A Ul ic_ ov�4 10 ")) 711-C It Date L hs t County Health Department Page 2 of 3 f P1'ICATION FOR: �� [/�!] New System [JV] Existing System [!d] Holding Tank [M] Temporary /Experimental [� Repair WI Abandonment [Ai] Other(Specify) APPLICANT: Do W 5a /1 a TELEPHONE: I�5 c8j5 o b; G� h tl i bC -�' r eA".),o 7 e AGENT: MAILING ADDRESS: 05 & xi G/ 53.3 4, in , 9 ?/ -? ?33 TO BE COMPLETED BY APPLICANT OR 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] LOT: / . . /q BLOCK: ?3 SUBDIVISION: ,g/)•7 54 5,. ® ,,��.- DATE OF r gg OO ✓✓ SUBDIVISION: r PROPERTY ID #: /'_d34:2.,— ®6 _0vV' ' / 3 / 70 [ Section /Township /Ran /Parcel No.] ZONING: PROPERTY SIZE: 0 ACRES [Sgft PROPERTY WATER SUPPLY: [ ) PRIVATE ,v [ )Y] PUBLIC • J 4. PROPERTY STREET ADDRESS: / 3 7 , 1 6, V 57 J Q7, qo 5 / OeZ S t� / e DIRECTIONS TO PROPERTY: C �s To q � -a �'° r--4- r .,_.r fl ,_ i:' n, 50 �_� 7� '` IN rR ; / + +c ADO . BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC 41 Garbage Grinders /Disposals [41-Ultra-low Volume Flush Toilets APPLICANT'S SIGNATURE: [y] RESIDENTIAL [ ] COMMERCIAL No. of Building # Persons Business Activity Bedrooms Area Sqft Served rt°) v/1,A 1, DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 1] which may be used) (Stock Number: 5744- 001- 4015 -1) PERMIT # DATE PAID FEE PAID $ RECEIPT #50 For Commercial Only Spas/Hot Tubs [4Floor /Equipment Drains [A*Other (Specify) DATE: Page 1 of 3 "3thcw" cify ty: fun Elam: nuido,:w c.:99!icrtat or w,,scni. • /V:•;, cat'r: c92!icr: • !....•.'2111.. a"! !ut !:1.1.1:g!ivi!•tion). cr f'.2cci bo •fic! r1.1!)t•:::vir.ion con (1: t::: dcto .7. of!. C,• I•Ci() cl)." 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