Loading...
PL-05-254Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 8/16/2005 Applicant: ALEXANDER Owner: YAHR JOB ADDRESS: 234 NE 92 Contractor THE NEW MIAMI SHORES PLUMBING Contractor's Address: 900 NW 144 ST Local Phone: 786- 553 -5424 Parcel # 1132060133410 Permit Status: APPROVED Permit Expiration: 2/8 /2006 Construction Value: Work: INSTALL NEW DRAINFIELD Signed: (INSPECTOR) Signed: Plumbing Permit Permit Number: PL2005 -254 YAHR ALEXANDER ST Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 8 & 9 BLK 25 LOT SIZE Fees: FEE2005 -11178 FEE2005 -11179 FEE2005 -11180 FEE2005 -11181 FEE2005 -11182 FEE2005 -11195 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Builders Bond Total Fees: Amount $175.00 $1.80 $0.60 $4.40 $3.00 $300.00 $484.80 Total Fees: $484.80 Total Receipts: $0.00 AUG 1 7 PAID 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 responisibility for all work done by either myself, my agent, servants or employes. (Contractor or Builder) BY: c0 {�� MIAMI SHORES VILLAG1fe BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date 2124 05 Type Insp'n 1) W1Yy ;i CIU ytro � , Permit No. i EI( J 2,54 Name J d 1 cW Address 23 l tiE St. �I Companyi € Au./ Mtctiiq 3i Js inkb1►t6 Phone # f 553 - 54 Inspection Date ( Approved Correction Re- Insp'n Fee BUILDING PERMIT ATPLICATIO FBC 2001 State Certificate or Registration No. (FCM9 0 $ Value of Work For this Permit Q �, Total Fee Now Due $ (Continued on opposite side) 484. 8'J Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No.12DOS.- 2 Master ermifNo. RECEIVED AUG 8Q5 Permit Type (circle): Building � Electrical Plumbing Mechanical Roofing Owner's Name (Fee Simple Titleholder Gl (�i� - i Phone # Owner's Address e4/ Mbfl higAtie City Mlddk or) State Ng Zip Tenant/Lessee Name Phone # Job Address (where the work is being done) ,a j2 NE gad shted City Miami Shores Village County Miami -Dade Zip Is Building Historically Designated YES NO Contractor's Company Name 1410771 Shores Phone -# .)5.751 a4 eP Contractor's Address 9Q, NW NV shed Cit Mani State F Zip % /W Qualifier Thnl3 fkah /!I7 Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Type of Work: DAddition DAlteration (1 1lew �Repair/Replace D Demolition Describe Work: 010211 r I/ d vwn - Hel d Code Enforcement $ Structural Plan Review. $ Square Footage Of Work: * * * * * * * * * * * * * * * * * * * * * * * * * ** *F * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ Notary $ Training/Education Fee $ O . C2 0 Scanning $ 3.00 Radon $ Zoning Bond W . W • CCF $ 1 • 5 CO /CC Technology Fee $ 1.40 Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVITS I certify that all the foregoing information is accurate and that all work willbe done in compliance with all . applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection whi occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be app and a reinspection fee will be charged The foregoin day of dU� Signature Owner or Agent Contractor trument was acknowledged before me this ‘ The foregoing instrument was acknowledged before me this , 20 0 by , day of 200 by J7/7/?i As i•�, tificaio i�. i d who did take an oath. who is personally known to me or who has produced who is personally known to me or who has produced ho did take an oath. APPLICATION APPROVED BY: chc 05/13/03 ************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** kip** * *t * ** ***************** * *** * * * * * * * * * * * * * * * * * * * * * * * * * ** ( Plans Examiner Engineer Zoning '!te7 ITEM BATH TUB UNIT • FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE BIDET LIGHT OUTLETS CENTRAL HEATING DISHWASHER RECEPTACLES A/C (WIND) DISPOSAL SERVICE TEMPORARY A/C (CENTRAL) DRINKING FOUNTAIN -- SERVICE SIZE IN AMPS DUCT WORK FLOOR DRAIN SERVICE REPAIR/METER CHANGE REFRIGERATION GREASE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING INTERCEPTOR RAKE TOP UNDERGROUND TANKS LAVATORY OVEN ABOVE GROUND TANKS LAUNDRY TRAY WATER HEATER U.F. PRESSURE VESSELS CLOTHES WASHER MOTORS 0- 1 HP STEAM BOILERS SHOWER MOTORS OVER 1- 3 Hp POT WATER BOILERS SINK, POT /3 COW. MOTORS OVER 3- 5 HP MECHANICAL VENTILATION SINK, RESIDENCE MOTORS 5- 8 HP TRANSPORTING ASSEMBLIES SIN(, SLOP MOTORS OVER 8- 10 HP ELEVATORS/ESCALATORS TEMPORARY WATER CLOSET MOTORS OVER 10- 25 HP FIRE SPRINKLER SYSTEMS URINAL IOTORS OVER 25-100 HP COOLING TOWERS WATER CLOSET MOTORS OVER 100 HP VIOLATION INDIRECT WASTES- A/C WINDOW REINSPECTION WATER SUPPLY TO: AIR CONDITIONERS A/C UNIT STRIP HEATER FIRE SPRINKLER GENERATORS TRANSFORMERS 'HEATER -NEW INST. GENERATORS TRANSFORMERS HEATER- REPLACE GENERATORS TRANSFORMERS LAWN SPRINKLER -WELL SPECIAL PURPOSE SWIMMING POOL OUTLETS COMMERCIAL WATER SERVICE SIGN TUBES SEWER CONNECTIONS SIGN TRANSFERS UTILITY -SEWER SIGN TIME CLOCK UTILITY -WATER FIXTURES SEPTIC TANK 0 ANTENNA RELAY TELEVISION OUTLETS DRAINFIELD, 4` TILE/RES. 0 VIOLATION PUMP & ABANDON SEPTIC TANK REINSPECTION SOAKAGE PIT CU. FT. CATCH BASIN DISCHARGE WELL DOMESTIC WELL AREA DRAIN ROOF INLET SOLAR WATER HEATER FIRE STANDPIPE POOL PIPING LAWN SPRINKLER SYSTEM GAS RANGE METER SET (GAS) GAS PIPING v.. ADDENDUM TO BUILDING PERMIT APPLICATION (AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ELECTRICAL MECHANICAL STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ X ]Repair [ ]Abandonment APPLICANT: Dascal, Elizabeth PROPERTY STREET ADDRESS: 234 NE 92 St Miami FL 33168 LOT: 8 BLOCK: 25 PROPERTY ID #: 11 - 3206 - 013 - 3460 SYSTEM DESIGN AND SPECIFICATIONS D [ 400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [. - '/ ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ `JI ]BED N F LOCATION TO BENCHMARK: FFE 12.0 I ELEVATION OF PROPOSED SYSTEM SITE [ 2.1 ] [ FEET E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0.0 ]INCHES OTHER REMARKS: DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) [ostds_cons_4016 -11 [ ] Innovative Other ]Temporary [ NA AGENT: WALLACE P, Ponder Wallace SUBDIVISION: Miami Shores Sec [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] T [ 1050 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS EXCAVATION REQUIRED: [ 42.0 ] INCHES CENTRAX #: 13 - - 26045 DATE PAID: FEE PAID : $ RECEIPT OSTDSNBR : 05 - 2614 - - SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] @ [ 0 ] DOSES PER 24 HRS # PUMPS [ 0 ] [ N ]MOUND [ N ] [ N ] ] [ BELOW] BENCHMARK /REFERENCE POINT 4.6 ] [ FEET ] [ below BENCHMARK /REFERENCE POINT 1. Install 1050 gal. category -1 septic tank equipped with an approved filter. 2. The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f), FAC. 3. Install 400 sf of drainfield in the bed configuration. 4. Install 12" of slightly limited soil @ the bottom of drainfield. 5. Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absortion bed. 6. Invert elevation of drainfield to be no less than 7.90' NGVD. 7. Bottom of drainfield el =- ati;.n to be no less than 7.40' NGVD. SPECIFICATIONS BY: Andre, P 1 TITLE: APPROVED BY: Andre, Pau ......------- TITLE: Professional Engin Dade CHD DATE ISSUED: 8/5/05 EXPIRATION DATE: 11/3/05 Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment APPLICANT: Dascal, Elizabeth PROPERTY STREET ADDRESS: 234 NE 92 St Miami FL 33168 LOT: 8 BLOCK: 25 PROPERTY ID #: 11 - 3206 - 013 - 3460 SYSTEM DESIGN AND SPECIFICATIONS OTHER REMARKS: APPROVED BY: Andre _Paul DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) tostds_cons_4016 -1] ]Holding Tank ]Temporary [ NA ] AGENT: WALLACE P, Ponder Wallace [ ] Innovative Other SUBDIVISION• Miami Shores Sec [Section /Township /Range /Parcel No.] [OR TAX ID NUMBER] L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 42.0 ] INCHES SPECIFICATIONS BY: Andr Paul i TITLE: CENTRAX #: 13 - - 26045 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05 SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT. T [ 1050 ]Gallons SEPTIC TANK MULTI- CHAMBERED /IN SERIES: [Y ] A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [Y ] N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ ' ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH [ )1 ]BED [ N ] N F LOCATION TO BENCHMARK: FFE 12.0 I ELEVATION OF PROPOSED SYSTEM SITE [ 2.1 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 4.6 ] [ FEET ] [ below ]BENCHMARK /REFERENCE POINT 1. Install 1050 gal. category -1 septic tank equipped with an approved filter. 2. The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f), FAC. 3. Install 400 sf of drainfield in the bed configuration. 4. Install 12" of slightly limited soil @ the bottom of drainfield. 5. Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absortion bed. 6. Invert elevation of drainfield to be no less than 7.90' NGVD. 7. Bottom of drainfield elevation to be no less than 7.40' NGVD. TITLE: Professional Engin Dade CHD DATE ISSUED: 8/5/05 EXPIRATION DATE: 11/3/05 Page 1 of 2 APPLICANT: LOTS g Q STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS Rik 6 -t BLOCK: PROPERTY ID #: It 7 t J .3 --- l QI ==== - - - -_ TO BE COMPLETED BY ENGINEER, HEALTH UNIT PROVIDE REGISTRATION NUMBER AND SIGN AND _______ PROPERTY SIZE CONFORMS TO SITE PLAN: TOTAL ESTIMATED SEWAGE FLOW: 3043 AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: $''cpto SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [ ] TRENCH [ REMARKS /ADDITIONAL CRITERIA: DH 4015, 10195 (Replaces HRS -H Form 4015 (Page 3] which may be used) (Stock Number: 5744 - 003 - 4015 -1) SUBDIVISION: A,f [Section /Township /Range /Parcel No. OTax IDTkusiberl EMPLOYEE, O ENGINEER'S MUST SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. ==_====================== YES [ ] NO NET USABLE AREA AVAILABLE: 33 ACRES GALLONS PER DAY - / OTHER -TABLE 2] GALLONS PER DAY [1500 GPD /ACRE OR CRE] SQFT UNOBSTRUCTED AREA REQUIRED: 00 SQFT AGENT: kb., f/ tom p hr-W' Sew _ M ! PERMIT � ._M - f ' _BENCHMARK REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS 77 ( [INCHES /S) / CHMARR FERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: FT DITCHES /SWALES: /Mt FT NORMALLY WET? [ ] YES [W WELLS: PUBLIC: FT LIMITED USE: A'ALFT PRIVATE: ,3 FT NON- POTABLE: / BUILDING FOUNDATIONS: - FT PROPERTY LINES: FT POTABLE WATER LINES: /25 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING? [ ] YES [t4 N O 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: 9, 9 FT MSL /NGVD _ SOIL PROFILE INFORMATION SITE 1 \ , SOIL PROFILE INFORMATION SITE 2 USDA SOIL SERIES: BED [ ] OTHER ( SPECI FY ) Munsell Color .Texture Depth ark ®i ! ; � � S, "�- d ( to 7? OBSERVED WATER TABLE: A /bINCHES [ABOVE / BELOW] EXISTING GRADE. TYPE; ESTIMATED WET SEASON WATER TABLE ELEVATION: 76, INCHES [ ABOVE HIGH WATER TABLE VEGETATION: [ ] YES [f 0 MOTTLING: [ ] YES [ _ - =' 0 / to to to to I to to to to PERCHED / APPARENT] ] EXISTING GRADE. DEPTH: /V/0 DEPTH OF EXCAVATION :.. INCHES 'Page 3 of 3 SEWAGE FLOW: INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY ID NUMBER: PROPERTY SIZE: UNOBSTRUCTED AREA: MINIMUM SETBACKS: FLOOD INFORMATION: SOIL PROFILE INFORMATION: WATER TABLE: SOIL TEXTURE: 27 character number for property (property appraiser ID number or section /township /range /parcel number). Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential), Chapter 10D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet Minimum setbacks in Chapter 10D -6, FAC. The unobstructed area must be contiguous to the drainfield. a ! BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be verified. Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be determined. Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth. Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION,: If applicable record depth excavation required. Recordr"NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted. WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 ( + ] SHOT H.I. H.1. [ - ] SHOT SITE 2 H.1. [ - ] SHOT SITE 3 H.I. [ -1SHOT Notes: APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number DH 4015, (Replaces HRS-H Form 4015 which maybe used) (Stodc Number: 5744- 002 - 40156) STATE OF FLORIDA DEPARTMENT OF HEALTH PART II - SITE PLAN Signature Not Approved Fek Ie Site Plan submitted by. ��. �� �l� � � � ___ PellttI6L, Title Plan Approved . Date 3 � � By. , ' County Health Department ALL CHANGES US = E APPROVED BY THE COUNTY HEALTH DEPARTMENT Page 2 of 3 g f= Loh block represents 5 feet and 1 inch =50f =et III ■ ; } t 5 sae t - +s t f d o ,---i---+--± C --, -5 i - Y � ■ ■ ■IINI■ -.. b .. _ v � 111 OE ■5■ ■■ t t i>n Ill! .2:� ---,-- i t !r �■. ._ uN■ ■ 4 4 4 I j t 1 ;. 4 ; f i ■■ ■■ MIN MUM ■■ t 5555 #n. till ■ � ■uwAi ■ " ■ ra Is u .� + _, .� ? ... .. ■i V on I UMW � W ' s u AmMOXI SR 6 f a 7 i YriAl ■ ■ l•� � ..1. ■ ■ O •• u au ..u. ■■■■illi� ■MY■■■� ■� .. y � � f i ■ i. .. . " ■■a XX [t ■ ■ ■■ o ..■■■■■■■•ti5 ■5 • ■ _ ismossuommus L_1 Lam _ � ■ �� � 11111111111111111 ■ ■ r4� � L � t_..�� � j -�—� -� - t � 5555■■■ ■■■ ■ C , �- , , C MR •• ■ • 1111110111111 I DMIR w imam 1111111111111111111111111111 1 f a i n ■ �� Ey • ■ N ■� 1 i■■■ ■ IN ■ ■ ■ ■ ■■ ■■■ ■E . ■ MN . ■ ■■ ■■ ■ t � � ■ 555!5 • Y !■■ i s ■■ ■. _ ■5 suUu • ■ J , ■ 5 ■`.., 11 w '. ■ • T OM r 5■ UM ■ ■� 5 Nur clew awe Ea _ lam . _ 5 / E As1 .s>E m i5�i IitlrK'r o , 5■�,. s.... my" " r ,�l 11 m.�[. mum ti rri .r a�1101111111111 .. ail ■■ ui■ ■i i I wit RS IMP 111 111 ammaium ism en • °- P i SKIN ■ ■555 ■■■ t f -a- r .t I M55 !? t F rid f ■Ada'A Notes: APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number DH 4015, (Replaces HRS-H Form 4015 which maybe used) (Stodc Number: 5744- 002 - 40156) STATE OF FLORIDA DEPARTMENT OF HEALTH PART II - SITE PLAN Signature Not Approved Fek Ie Site Plan submitted by. ��. �� �l� � � � ___ PellttI6L, Title Plan Approved . Date 3 � � By. , ' County Health Department ALL CHANGES US = E APPROVED BY THE COUNTY HEALTH DEPARTMENT Page 2 of 3 Scale: Each block represents 5 feet and ! � 1 inch = 50 fe =t. EL. .. MIMI II1■ am ■�■■� .: i ni '. '°` ` 4 ", _ r © .. . .� - / ) : ^\ \� glinnli ■ P2:■ ■ t ■ ■■■ ■■ , '■ _ e , ■■ s. Y muu ■■■ . . • -. �A1 / ■ ■�r Um a r ., ., �. E . �'* F C �. ■ � ■11f .�... y . �e . a t. i • \ -k« -d2 d {i: ,. 22 f 1 yy / .4.,,,77 \ ( L am: MEI kill • MIN Mina maw Um MOM MIN SHE Hi II MI ` I■ ■ ■■ ill nua ill s■ ■■ ■ ■■■■ ■■ mums ■■ ,tip 111111111111111111011111111101111 T w ■■■■■■■ III 11111111111 ■■�r .. ,_� ` � ■ ■ ■■■ ■ ■■ l ■ ■ 11111111111111111111MIMUI II !J ■il ■■ ■■.■ ■ L »«- ; \ � I \ I _ ; , II 111111111111111111 1 11 = a■ t_ ■■■ ■■ f ! sia aim • L k: „. LIT $- . r im \ ��) 111110111111111111111 . III las • 1111111111 i ���� .. .. ._. .... uiu■u■ n ■ l� s j + s i' • u 8 .I<■. ■■ .� ti, ■ I _ - IMMUI !da. . -- _ i. ■■ ■IC _. _. it i���l r � ' UUI _ ��.� �I! it�l iii - ■■ �i i I■■'i�l iii ■■■ice ■ ..,- momumam III SS # �i 111111.171 1111 117,11 � _ ■ . _ ■ { t _ `�' _ „ i �� �� � J1� Ply �i. &. Notes: Site Plan submitt Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Perini' Application Number PART II - SITE PLAN ALL CHANGESMUS BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4016;10"96 (Replaces HRS-H Form 4016 which may be used)N (Stoll Number: 6744- 002 - 40156) .� ^. aye vs YO ' s' tf' 12 d "� e 1.1, ex, 7 /7s ..j Dat County Health Department Page 2 of 3