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246 NE 92 St (8)4? °M IAMI ORES VILLAGE BOLDING DEPARTMENT 305- 795 -220 8 wing Bui Inspection �u t Type Insp'n �' - ) C.. C -kj• brdt Permit No S — iz$ . Name- �C11nOlCD • Date►° Address : Gic Company N e slept IC, Phone # Inspection Date tOI i q G3 Approved Correction L0/ Re- Insp'n Fee ❑ mOE 13 25 V MIAMI SHORES VILLAGE V BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n La( C9p■+NG Permit No. T i OS 2.25 1 Name ( 2.12C- \ iC S Address 2*z" 1iE q Company PI Y , Phone # Inspection Date \ \\ I C Approved Correction Re- Insp'n Fee Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 7/22/2005 Applicant: JAVIER Owner: REYNALDOS JOB ADDRESS: 246 Contractor MR C'S SEPTIC TANK Local Phone: 305 - 651 -7859 Parcel # 1132060133400 NE 92 Plumbing Permit Permit Number: PL2005 -225 REYNALDOS JAVIER ST Contractor's Address: P 0 BOX 693239 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 W4OFT OF LOT 6 & LOT 7 BLK 25 LOT SIZE Fees: FEE2005 -10072 FEE2005 -10073 FEE2005 -10074 FEE2005 -10075 FEE2005 -10076 FEE2005 -10077 Description Building Fee CCF Training and Education Fee Technology Fee Scanning Fee Builders Bond Total Fees: Amount $350.00 $1.80 $0.60 $8.75 $3.00 $300.00 $664.15 Total Fees: $664.15 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 1/17/2006 Construction Value: $2,000.00 Work: TO INSTALL SEPTIC TANK Signed: (INSPECTOR) Signed: (Contractor or Builder) Page 1 of 1 aq 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. BY: BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical • 0 ®I4) Owner's Name (Fee Simple Titleholder' Owner's Address ,V C ity rie7tu Tenant/Lessee Name Job Address (where the work is by City Miami Shores Vi' Is Building Historically Design Contractor's Company Nam Contractor's Address City r ' ' Qualifier 1 State Certificate or Registration No. $ Value of Work For this Permit vi Type of Work: Describe Work: Total Fee Now Due $ ❑Addition riS 37S )0 (Continued on opposite side) Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305 756.8972 5`- SSTII ['Alter; Training /Education Fee $ Radon $ 2ew 4 2 T L Code Enforcement $ Structural Plan Review. $ Permit No.3O5 " 72 -5 - Master Permit No. Mechanical Phone # °4s'7Z Roofing _Zip one # _ Zip 93, ❑ Repair /Replace frierA. /of Competency No. Architect/Engineer's Name (if applicable) Phone # Square Footage Of Work: ❑ Demolition * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 5='. 3 (cam CCF $ 1 • c) CO /CC ----- Notary $ Scanning $ 3 •OD Zoning Bond $ - 00 �• C=CD Technology Fee $ B•75 *- con 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. 1 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 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. "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 which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not .e approved and a reinspection fee will be charged. Signatui Owner or Agent Contractor The foregoing instrument was acknowledged before me this/'° The foregoing instrument was acknowledged before me this _ day ofd , 200,p_, by day of , 20 , by who is ers nall known to me or who has produced who is personally known to me or P Y p p y who has produced i As identification and who did take an oath. as identification and who did take an oath. NOTAR 'UBLI -- NOTARY PUBLIC: " ''' HEN Sign: Imo. E. COCKING Sign: Print: )�4')eJ I . %`'. e � s June 9 2009 C '' er, e;; o�yy-ibu�a.,..,ao,o Print: Chc 05/13/03 My Commission Expires: Signature My Commission Expires: ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * *** * * * * * ** * *** * ** * * * * * * * * * +k k / / / ' � ** * 4 ** 4 ******* * * * * ** * * * * * * * ** * ** * ** *4 ** * * ** ** APPLICATION APPROVED BY: ; % ` i Plans Examiner Engineer Zoning APPLICANT: Reynaldos, Javier AGENT: SA0990924, Suarez Guillermo STATE OF FLORIDA DEPARTMENT OF HEALTH t ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ X ]New System [ ]Existing System [ [ ]Repair [ ]Abandonment PROPERTY STREET ADDRESS: 246 NE 92 St Miami FL 33138 LOT: 6 BLOCK: 25 SYSTEM DESIGN AND SPECIFICATIONS SPECIFICATIONS BY: Andre, Paul APPROVED BY: Andre, Paul DATE ISSUED: 7/11/05 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 013 -3400 [OR TAX ID NUMBER] T [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 1 DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) (ostds_cons_4016 -1I CENTRAX #: 13 -SG -25437 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05 -2013- -N ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] 1 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, RPQUIRE 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 ] ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 375 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ Y ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ Y ]TRENCH [ N ]BED [ N ] N F LOCATION TO BENCHMARK: C/L of NE 92 Street El.:10.07'NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 3.2 ] [ INCHES ] [ BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 33.2 ] [ INCHES ] [ BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 72.0 ] INCHES OTHER REMARKS: 1.- Install 900 gal. category -2 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 375 sf of drainfield in trench configuration. 4.- Invert elevation of drainfield to be no less than 6.50' NGVD. 5.- Bottom of drainfield elevation to be no less than 6.00' NGVD. TITLE: TITLE: Professional Engin Dade CHD EXPIRATION DATE: 1/11/07 Page 1 of 2 STATE OF FLORIDA ,DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS tPPLICANT: Reynaldos, Javier AGENT: Guillermo Suarez, A- LEAGUE ,OT: 6 BLOCK: 25 0 YEAR FLOOD ELEVATION FOR SITE: 0 FT NGVD SOIL PROFILE INFORMAATION SITE 1 Mansell # /Color Texture 1 AYR -' /' -n RN _Sand 1nvR -5/7 -a RN Rand 1 nvR - 5/4 - V RN Anl i ti n T.i mama USDA SOIL SERIES: 15 Urban land Depth n to 14 14 to 4R 4R to 72 to to tO to to H 4015, 03/97 (Obsoletes previous editions which may not be used) Stock Number: 5744- 003 - 4015 -1) (ostds_eval_4015 -31 CENTRAX #: 13 -SG -25437 OSTDSNBR : 05- 2013 -N SUBDIVISION: Miami Shores ID #: 11- 3206 - 013 -3400 SA0990924 '0 BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S JUST PROVIDF RFC;TSTRATTON NTTMRFR AND SI(N AND SPAT, PACH PAGE OF SURMTTTAL. COMPLETE ALL TTF,MS. 'ROPERTY SIZE CONFORMS TO SITE PLAN:[X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.27 ACRES 'OTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [64E -6, TABLE 1] ►UTHORIZED SEWAGE FLOW: 675 GALLONS PER DAY [1500GPD /ACRE OR 2500GPD /ACRE] ' NOBSTRUCTED AREA AVAILABLE: 750 SQFT UNOBSTRUCTED AREA REQUIRED: 750 SQFT BENCHMARK /REFERENCE POINT LOCATION: C/L of NE 92 Street El.:10.07'NGVD ;LEVATION OF PROPOSED SYSTEM SITE IS 3.24 [ INCHES ] [ BELOW ]BENCHMARK /REFERENCE POINT 'HE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: ;URFACE WATER: N/A FT DITCHES /SWALES: N/A FT NORMALLY WET? [ )YES [ X ]NO 'ELLS: PUBLIC: N A FT LIMITED USE: N/A FT PRIVATE: N/A FT NON- POTABLE: N/A FT fUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 26 FT SITE SUBJECT TO FREQUENT FLOODING: [ ]YES [ X ]N0 10 YEAR FLOODING? [ ]YES [ X ]NO SITE ELEVATION: 10 FT NGVD SOIL PROFILE INFORMATION SITE 2 Mansell # /Color 1nvR -' /1-n RN 1 nvR -5 /a -r lam 1AYR -5 /4-Y RN Cann n tO 14 Rants 14 tO 4R Anl i ti r• T,i mcaa AR tO 79 to to to tO to USDA SOIL SERIES: 15 Urban land Texture Depth PBSERVED WATER TABLE63.00 INCHES [ BELOW ] EXISTING GRADE TYPE: [ PERCHED ,STIMATED WET SEASON WATER TABLE ELEVATION:64.00 INCHES [ BELOW ] EXISTING GRADE. IGH WATER TABLE VEGETATION: [ ]YES [X]NO MOTTLING: [ ]YES [X]N0 DEPTH: 0.0 INCHES INCHES OIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:Replacement/0.80 DEPTH OF EXCAVATION:72.0 'RAINFIELD CONFIGURATION: [ X ]TRENCH [ ]BED [ ]OTHER (SPECIFY) EMARKS /ADDITIONAL CRITERIA: ITE EVALUATED BY: Guillermo Suarez DATE: 7/7/05 Page 3 of 3 Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date - 1/z1 /os Type Insp'n r'h co 1 Permit No. -R-0-5 Z-ZS 1 Name J ALA C 0 12'G 1 8 O Address 2 4 E. 9 2. ST Company NI V. C' 5 Sap-1-r G Phone # Inspection Date 7 22. v5 THE O'NEAL IA LOCI< & SEPTIC TANK C 1338 N. W. TWENTY -NINTH STREET MIAMI 37. FLORIDA 10 THREE ION ELEPHANTS C0U10 NOT CRUSH AN ! CIN BLOCK �..�. Shores Village 9 Shc_ : -os Vil1_a •e 9 Florida *£ IUNtTiO STAlS .PO:TAGC' t BUILDING ELWTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Description Address of Building 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. A Signed: By SPECTOR -1 consideration of the issuance to me of this permit I agree to perform the work covere ereunder in compliance with j dinances and P tions dk•taining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper aiktilelPities of Miama&-Hrii s Villag In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee. f / .( CONTRACTOR (R BUILD ft] MIAMI SHORES VILLAGE, FLORIDA DATE /— ERMIT N9 3532 Work to be performed under this Permit Bl. I Subdi- vision Value of Project 194 Contractor's License No. ;- •• Crwg:r1 rpay b iri ut)la '2. (It' • , 'Ierj krriit.4r4L , ,,:r 41 t.i d lc COt y{:tr t't.; • ldi!ce be,nru sta:asig ot ptilluyi:"„!,..■ :f :II'S peraiit. Amt. of Permit BY AUTHORITY A A , BUILDING ELECTRICAL PLUMBING Owner of Building _ 1 MIAMI SHORES VILLAGE, FLORIDA PERMIT N9 3532 Work to be performed under this Permit . . r/ Id) CCIISI Enlr+ Architect _ —_ _ _ _____ cifrC Contractor���:� or Builder Legal Lot BI. Description Address of Building 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 o° 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: By INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regula- tions 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. Subdi- vision Value of Project DATE 194_ — ∎1 ti'n.�l' ljr Contractor's License No. Amt. of Permit CONTRACTOR OR BUILDER BY AUTHORITY BUILDING ELECTRICAL PLUMBING ROOFING MIAMI SHORES VILLAGE. FLORID ❑ DATE 195 0 PERMIT Ni? 5194 Contractor's /) License No. Work to be performed under this Permit f / ` Owner of Building Architect Contractor = or Builder Legal Lot Description Bl. Address of 4 Building CONTRACTOR OR BUILDER Subdi- vision Value of Project $ Amount of 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 cr in the statements or / specific tions and that he assumes responsibility for work done by his agents, servants or employees. Signed BY INSPECTOR 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 ac- cepting this permit I assume responsibility for all work done by eithgr, myself, my agent, servant or employee. tr . BY AUTHORITY 6 e f i - u,� dad.- d, 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. / Owner's Name and Adores C>_____ CA2.._ re). �✓ ! _-- .---- ---------- -_ - --- No -`f_ 6 Street•- 9 Z Registered Architect and /or Engi Employing Plumber's Name Size Septic Tank Feet of Drain Tile STATE OF FLORIDA, ! COUNTY OF DADE. Nature of Water Supply: City —Well.. MOAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING rt -,i, MIT — -e No._ Dat Street.__ rte&. & / - s Location and Legal Description Lot._____.__ .... ___________ Block Subdivision .- -------__._---. - _----•--__---- Street and Number where work is to be performed— No.___ ° 4L -Z /E 9' , street - State work to be performed and purpose of building (By Floors)_____.__ ..... _ .... __-_-______ New Building ---- •- ----- ..- --- _ -. -.. Remodeling___ -_— Addition- -- Repairs No. of Stories - - .-- --- ••-- ---- -___ -- __ __ __ — ._� Type of Tank _ Capacity Gals f ` _Dist. Feet of Tank or Drain Field from Well ------ - - - - -- A-03' __Size Amount of Permit $ ll ----------- --- -- -- -- — -- (Signed)_ __-- -- __Size of Soakage Pit (Signed)._ My Commission Expires Notary Public, State of Florida g Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as mployer of labor under the Florida Worlanen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Suppl - ent, 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 w• uch public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to • . erformed under this permit, as are lid by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized 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 TUBE SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINAL S CATCH BASIN FLOOR DRAIN DRINK NG FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK ?' SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SW I P001. CONTR. LIST _ - -- - CHUCK 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. / Owner's Name and Adores C>_____ CA2.._ re). �✓ ! _-- .---- ---------- -_ - --- No -`f_ 6 Street•- 9 Z Registered Architect and /or Engi Employing Plumber's Name Size Septic Tank Feet of Drain Tile STATE OF FLORIDA, ! COUNTY OF DADE. Nature of Water Supply: City —Well.. MOAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING rt -,i, MIT — -e No._ Dat Street.__ rte&. & / - s Location and Legal Description Lot._____.__ .... ___________ Block Subdivision .- -------__._---. - _----•--__---- Street and Number where work is to be performed— No.___ ° 4L -Z /E 9' , street - State work to be performed and purpose of building (By Floors)_____.__ ..... _ .... __-_-______ New Building ---- •- ----- ..- --- _ -. -.. Remodeling___ -_— Addition- -- Repairs No. of Stories - - .-- --- ••-- ---- -___ -- __ __ __ — ._� Type of Tank _ Capacity Gals f ` _Dist. Feet of Tank or Drain Field from Well ------ - - - - -- A-03' __Size Amount of Permit $ ll ----------- --- -- -- -- — -- (Signed)_ __-- -- __Size of Soakage Pit (Signed)._ My Commission Expires Notary Public, State of Florida g Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as mployer of labor under the Florida Worlanen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Suppl - ent, 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 w• uch public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to • . erformed under this permit, as are lid by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized 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.