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386 NE 92 St (10)BUILDING ELECTRICAL PLUMBING Contractor Y k or Builder -J r L/ Legal. Lot Description MIAMI SHORES VILLAGE, FLORIDA PERMIT N° 6387 Work to be performed under this Permi Owner o£_ Building >,> Architect ls% Bl. Subdi- vision Value of Project BY DATE Contractor's License No. J Amt. of Permit 194 Address of / / y' _ �y' % �.% Building ''; /? ;� : / This permit is granted to the contractor oi.ui der name ab ve to construct the building or to install the equipment or de ice described in the appli- cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 ii the s ments or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. � , =' .,:-/-„,, Signed: a E: '4 ; , .• 04 By SECTOR • loterla In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with ah,.ordinances and4egujaiions pertaining thereto and in strict conformity with the plans, drawings, statements or specifications su mitted to the proper authorities of Miami ShoteSVillfge. In acce ththispermit I assume responsibility for all work done by either myself imy age e v or e 'ji ibyee. CONTRACTOR " B : S DER AUTHORITY Date PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 3 tto C . 5 2 Sfe Pifax Folio Legal Description Historically Designated: Yes Owner/Lessee / Tenant Hie , V ,f}k,ey 7ti/7`C,4 2A' le.kAtiAc 1 Master Permit # Owner's Address 3feo N-' E. '72 P 7L Phone Z5 – 5—, Contracting Co. e ate tJ� G Vhf t' Address y�ifr� "`. 693239 Qualifier SS# State # Municipal # Competency # Ins. Co. Address Architect/Engineer Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ` �� C �, •� �` Square Ft. - s cnO of owner • Condo Presi otary as to.D y n Commi i Q cS er and/or ` C•ndo President Expires: " BURDINE THOMPSON My Commission CC409057 Expires Sep. 22, 1998 Bonded by HAI 800- 422.1555 p e) FEES: PERMIT , RADON APPROVED: Zoning Building Mechanical Plumbing C.C.F. Phone Estimated Cost (value) l (SO 0 c 3� Electrical No 3 3-F4 6S 1 78 3326 S� 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. Signat r of Contractor or Date %ate► ! Il ems._ otary as to •ntractor'Owner- Builder y Commission Expires: BURDINE THOMPSON My Commission CC409057 Expires Sep. 22, 1998 Bonded by HAI 444 OF R 800 -422 -1555 NOTARY TOTAL DUE 3 0 ° ngineering STATE OF FLORIDA .: '-''''1& PERMIT # '1 a DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ C,0 CONSTRUCTION PERMIT RECEIPT # Authority: Chapter 381, FS & Chapter 10D -6, FAC CONSTRUCTION PERMIT FOR: [Pi] New System [P" ] Existing System [I ] Holding Tank [d] Temporary /Experimental [g] Repair [NI Abandonment [A)] Other(Specify) APPLICANT: rir.. /31 ( ` / ) l t et4 PROPERTY STREET ADDRESS: 3 C A) E .. , e L � � � . e :54 * ; 3 j 3 1 LOT: )j BLOCK: i/ SUBDIVISION: AYA PROPERTY ID #: J�� [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] � [OR TAX ID NUMBER] 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. HRS 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. SYSTEM DESIGN AND SPECIFICATIONS T [IJJ7'Q ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ -°' ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ .— ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D [3 00 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [./] STANDARD [ ] [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [ ✓] BED [ F LOCATION OF BENCHMARK: /(9. ()Ci T:. ( pi ll /i( T "Y b.,4)“..1\ I ELEVATION OF PROPOSED SYSTEM SITE [ /1/4 J [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ t‘)/k4 ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: ['JO-44] INCHES EXCAVATION REQUIRED: [ 3 6) ] INCHES GP 5 - tr. / It L TJI✓/4 4 7 �� ldae `JFZ (ii" 7 4,, „ 7� d j 0 T H E R :1-14 >C?r H. L. . facl 1- "0 14- ,), "- 4-¢ re /c •- 4 SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: 4 %� AGENT: Fi ' 1 v TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016-0) TITLE: 2 3 ( ) L j 1.J EXPIRATION DATE: I r CPHU Page 1 of 2 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 H 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 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. CONSTRUCTION PERMIT FOR: [H-i] New System [''1] Existing System [d] Holding Tank [ " ] Temporary /Experimental [^() Repair [f%] Abandonment [:] Other(Specify) APPLICANT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: STATE OF FLORIDA a - • " PERMIT # DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ CONSTRUCTION PERMIT RECEIPT # ;ia--, Authority: Chapter 381, FS & Chapter 1OD -6, FAC t' :��' BLOCK: 1 . "l SUBDIVISION: SYSTEM DESIGN AND SPECIFICATIONS SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: i _ AGENT: ; j � A ;f x i 6r y C [ SECTION /TOWNSHIP /RANGE /PARCEL,NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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. HRS 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. T [.“;,,∎ ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ 4 ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ -- ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY... DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D [ • ;p .e ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ '] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [ • BED [ ] N F LOCATION OF BENCHMARK: I 0 j _; ' 1-- ° • "° ",-.1, 6 - i i /. , o I ELEVATION OF PROPOSED SYSTEM SITE [,.If ] [INCHES /FT} [ ABOVE /BELOW] BENCHMARK/"REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ;; -j ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [J INCHES EXCAVATION REQUIRED: [ . T ^' ' l s0 j '+ > H E R :, { i ;,4, -. J 1 . I' ! ! TITLE: TITLE: . l� HRS -H Form 4016, Mar 92 (Obsoletes previous editioris 5ohich� ,, be usacpr, n P� (Stock Number: 5744 - 001 - 4016 -0) "�� � �' H A' JG INCHES EXPIRATION DATE: /• CPHU Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. AP?UCATION 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. AVAILING 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 n or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D-6, FAC. DRAINFIELD: Minimum specifications from Chapter 1OD-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. LOT: PROPERTY ID STATE OF FLORIDA BLOCK: PROPERTY SIZE CONFORMS TO SITE IrA [ ] YES TOTAL ESTIMATED SEWAGE FLOW: GALL AUTHORIZED SEWAGE FLOW: GALL UNOBSTRUCTED AREA AVAILABLE: / SQFT BENCHMARK /REFERENCE POINT LOCATION: SUBDIVISION: SOIL PROFILE INFORMATION SITE 1 a) -r — 4, Muns USDA SOIL SERIES: Color ' Texture Depth D to /'- to ol Y to to to to to to to OBSERVED WATER TABLE: � INC S [ABOVE ESTIMATED WET SEASON WATER 'TABI LEVATIO HIGH WATER TABLE VEGETATION: [ YES [ NO SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [ ] TRENCH [ BED REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY: HRS -H Form 4015, Mar 92 (Obsoletes previous edition (Stock Number: 5744 - 003 - 4015-1) hich / DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS AGENT : � 4 ! , `7 [Section /Township /Range /Parcel No. or Tai ID Number] TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSO ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. 'COMPLETE ALL ITEMS. [ ] NO NET USABLE AREA AVAILABLE: ACRES ONS PER DAY [RESIDENCES -TALE 1 / OTHER -TABLE 2] ONS PER DAY [1500 GPD /ACRE OR 25p0 GPD /ACRE] UNOBSTRUCTED AREA REQUIRED: 4 6 SQFT ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: /40 FT DITCHES /SWALES: /®®U FT NORMALLY WET? [ ] YES [v,4 NO WELLS: BUILDING FOUNDATIONS: ,J OUNDAT ON FT LIMITED USE: PROPER � TY LINES: PRIVATE: FT ��POTABLE WATER LINES: Afe FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING? [ ] YES t,/ NO 10 YEAR FLOOD ELEVATION FOR SITE:. FT MSL /NGVD SITE ELEVATION: FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 L'. Muns - 1 Color - tur Depth to to to to to to USDA SOIL SERIES: EXISTING GRADE. TY INCHES [ ABOVE MOTTLING: [ ] YES PERMIT # )s'' " 15 : [PERCHED / APPARENT] BELOW ] EXISTING GRADE. NO DEPTH: INCHES DEPTH OF EXCAVATION: INCHES OTHER (SPECIFY) DATE: Page 3 of 3 ; NS - RUCTIONS: • P E'RM7 0: Permit tracking number assigned by CPHU. Ay'c ?LICANT: Property owner's full name. ACENT: Property owner's legally authorized representeive. F.C?, 3LOCK, SUBDIVISION: Lot, block, and subdivision for lot. 1.':30?ERTY /DO: 27 character number for property. ( property rpprciccr ID C r section/township/range/parcel number) ?:3C7.'ERTY SIZE: Check if property size at site conforms to submitted site ph: :n. Record net usable area available - lot area exclusive of all paved r:e ^_a cn prepared road beds within public, rig1 :r, -of- -way or easements and exclusive of streams, lakes, normally wet drinage ditches, mantles, or otter such bogies of water. SEV/ACrE FLOW: .1\ D ARE/ Record du: estimcted sewage flow for the est bit- s3 :,cnt t z a Table 1 (residences) or T able 2 (non - residential), Chapter 10D -6, IFAC. .:beco:d the authori-._eet swage low for the "ot based en net unable area and water supply (1500 gallons per day pf:2 cc or private water supplies acs ". 2.5C 1 gpd :; r acre fee public water supplies). Ilf cuthoraed sewage flow dces not ec uaI c: exceed the estir^r?ed cewrg ; plicction must be denied. Record t! -^ c feet of unobstivc>_ed arec r , r'.`, ;': r° ';:e amount required. Unobctructec area must be et last 2 times cc large r.:i to drainfield cbsc-ption c :w : :t !sr:.: 75 percer:i of the unobstructed area Muni meet minimum s : :tbecl.s l . C :?: ,t :r !C: -6, IFAC. ?he c.,„a:; __ : :s'e1; c_e. must be contiguous to the ■reinfield. 1' V A 1.K LNFORIV.: Record th.: ':ox :.:o:: u ih ch n . :s. ^b.. :'a b:; rk c.:screl the acWal elevation. Record }e elevation of tier pro-,e d system c1 :e in rely :.c�: (cbov:: c: below) io the Eercl3mark. 3N :1/ Ji1/e SET 3ACN.S : Record 'nir: setbacks which can be meet '! Ii _r feature. Ariu s1 sr_essu!emeats must be recorded or 'NA' for non r•n!ic . b!c features. ''ea_•• or ci.^ -. a: w'.' ';71 75 fee: of the applicant tot must be meas The location of any public t. :inking well within 7.00 feet c opi.ic: -:t'a !oi must also be verified. _ L ;CD INFORMATION: Record info;- :r?ion on lot's subjcc' to f°.onn :23. ;-c: In: . subject to flooding record 10 yea: flood elevation for site and actual site elevr.tior.. :iOFIP 1E INFOIIci!' /.'''.`.CN: Two soil profile: within the proposed abso ?:io,a: uc :L i minimum depth of 6 feet or :refusal are required. Soil identificr.tion 'i1.'. z.ts' USDA Soi! C!cssificc;on methc'clogy (Muneell colors and USDA coil textures). Refuafllo must be clearly ducuirente. Provide JS.. A soil +: e. :ra if EV:.i!able, record "�JNK" if the series cannot be determined. WATER TABLE: Record the depth of the observed, water tab rc t %.e :um of the evaluation. Mark "perched" or "apparent" as approp- ;r.te. T:eco. d the estimates; wet sea :'n. -: wets: ^..c1; . e elevation bated on site evaluation,-USDA coil maps, and historic:.1 info -x_ ition. Indicate if there is :gig: - .7: e:: e vegetation present. !Indicate if mottling is present and depth. SOIL TEXTURE: Recorn coil texture or loading r :e for system sizing. ;DEPTH OF EXCAVATION: If applicable record depth of excavation required. I cecrd "NA" if not applicable. IZtAINIFIELD CONFICU;RATION: Check drainfield configuration required. If otter, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or ins;c_lation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evr.tuation. Professional engineers must seal all documentation submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT RS: BENCHMARK SITE I SITE 2 SITE 3 [¢] SHOT: H.I. H.H. H.I. H.H. [ -] SHOT [ -1 SHOT [-1 SHOT' Scale: Each block represents 5 feet and 1 inch = 50 fee ✓' . 7,0- 5 ' - '1' " ' ��■■■■ I I 1 1 nl i Ei ■ ii' ii■■IA ■� ■ ■■ � 1111■■■■■ ' • ■ IU 1111■ : :: % ■ ■ ■ ■ ■■ I ■UU 1111 - U M WI i ■ ■ ■■■ ■ ■ ■■ C ■ ■ ■�■ 1111 1111■■ ■ � ... TIM NENE �•• 'i'■ ! E 1I I IP b IU LI i IEi 1 I SS C . 1 ■ ■ ■■ � 1■ ■■ • ■ j 1 • 11•11111 �■■1n■ u • 1111■■■■ ■ — ) I .1111 - M IN -- - -r- - -- - - - - - - -- '!' Eli 1111■ • ■ • I 0■ ■■■ u E ' III rif 1 1 L 1111.. : . L_' H WWI n_ ■� ■ E ■o ■" • ■ i I I i I r ( ■ I ammo Tift II. • -I - i 1 ■�� ■ ■■ { ■ • 1 NM - - I 7 - - I / - -J_ _ - T - - I- 1 — — I t fI 11 I I 11 1 L. -_.u._ I_LI 11._ 1 11 _1_L_I_ __1_x..1, _ - 1 . -- F I 1 -_ . - _. 1 I I r 1 1_f- l I - 1_I _ 1 -._ L P4E I - -__ r I I 1 1 = 1 ` � - 1 - . _ V[ = 1 =1= 1 - I = _ [! -, _ _ :C 1 ' ■�■ 1 - a Tr III - -.I 1 1 1 • n I - - - L(I 1 I- i I 1 n W �. -- 1 1 -- 1 _ I _I- - -- 4 1 1 •' x -- -�' I 1 1 . _. Notes: Site Plan submitted STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTI9N PERMIT r Permit Application Number %5 /// 9 oL re,,o/c- HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6) PART II - SITE PLAN Not Approved / Q /Q ° Plan Approved 4 By t it -� r f i r l 9 a f'r' Y --;')/) - AUL C MUST BE APPROVED BY THE COUNTY PU = LIC HEALTH UNIT r TITLE r Date / `�f County Public Unit Page 2 of 3 Scale: J 'Each block represents 5 fee t and 1 inch = 50 fee _1 L i f 1 I�1i lim I II1 I� - Pr"- II — — J -- - 17 - - 11 1 1 f 11- 1! II J I I I I I I 1 11 I I I I 1 CI I _ I - I� 1 -. _ I _ I_ I 1 _I -- 1� I . I I _I_. I_ 1 E I _._ I 1 I_ _ I I [1 I L -- I I I _I_ _I -_III I. 1 � I II I J I i JJf j( ! = I_ i i I�_ J: I i 1 I I I 1 1 I - -.- II 1 1 J I 1 1 1 1 ! T � I 1 -1 F-1- I_ I I I� (^ I f I L; J H 1 I I _ I I 1 1! 1 I [ 111_ I! 1 1 I 1 I i T ! ! I� i i 1 7 1 1 { ( i 1_I I III I __ I I_ 1 1 1 1 1 1 L- 1 L I 1 I J_CJ 1 I 1 1 -1 i I I I 1 1 1 1 11 1 1 1 _! 1 1 1 L 11 Id 1 1 17 1 1 11 L I._ L- I 11 ! 1 . '- J 1 1 1 I I ! I l ! 1 1 .._ ' 1 __ _ �- 1 , -11 _: _ 1. _ 1. J L I i 11 I . I . -1- 1 1 1 J J I 1 1 1 1 1 J 1 r I I I I 1- 1 l .l T I I r 1 1 _i _- 1 . 1 1 I 1 l _. I 1 I _ 1 1 I 1 1 I I T _ -- .J. I i 1 . J i I1 1 =1 l j l - r _ I I, 1 I I I T r - J r r 1 ! I 11 II:- 1 ! . L_ _ _ iJ 1 1 1 L 1 1 1 1 f I -7 .1 .I 1 1 I 1 I } .. I I _ I 1- , 1_1 1 - . 1 _ i 1 I i i T 1 1__ I 1 I L I _I 1 I _ i�� 1 i Ti l i 1 1 1 r r S )p .'—',-r= _ 1 1 1 1 I I i 1 I1 I I I I _51 " �II I J 1 1 1 1 1 1 1 III I I I I i I I L ;f -r Jf b i I I I 1 1 1 I I I 1 �_ �. _ ._ ._ f 1 L Jr __ I� �f � - -- I U - f 1 I - I- I )_ I I I 1 C _= 1 � - : I f I I IT_ I I _ I_ I LL r ! ! I f III i j 1 r L 1 I �_. I f( I I (� I- 1 1-I- r1 _ I I LI 1 _ 1 1 11 H ■ ■■1 ■ ■ ill I ■ L 1 I I I 11 1 L l i d , - 1 ■■■■ ■■■r ■ E 1 • ■ 1 1 81 ■■■. ■ =a I■■ TI! .0 1 • I# ri ram r... ■jam / ■ ■ ■ ■� _ / � ■ t t r r I 1 kv _ _■■■■.�■ ■■ ■■■■G ■■■■ ■■ ■■■�I■ ■■ ■ • ■ i • Or I 1 1 III 1 :�::':�:::::::�� :: ■ .. ■ ■ ■ � .0 • I II {T1. 1 I ■1 ■� ■ • I ■/ mil I I 1 1 I T � ■1�■■ E ■U ■■■■■■■ ■■■■■■■! E * e � r ; . % W ■ I ■■ I ) J ! I_ ' . Notes: Site Plan submitted by: SIGNATURE Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND°RE1 -IABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744 - 002. 4015.6) PART II SITE PLAN Permit Number ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE , Q / qC Not Approved Date County Public Unit Page 2 of 3 APPLICATION FOR: [ A New System [ ] Existing System [ ] Holding Tank [V] Repair [ ] Abandonment [ ] Other(Specify) MQ APPLICANT: �,y� / e-A) , Q', ' `7�s�e�1 AGENT: MAILING ADDRESS: 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: PROPERTY ID #: PROPERTY SIZE: PROPERTY STREET ADDRESS: 6 / E. �✓�s ; ! s 9 ( _� 4 ,9 DIRECTIONS TO PROPERTY: dt5 y am ¢ J BUILDING INFORMATION ( %RESIDENTIAL Unit Type of No Establishment 1 2 3 4 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 APPLICANT'S SIGNATURE: Mt, c z), 6 9 BLOCK: SUBDIVISION: [ ] Garbage Grinders /Disposals [ ] Ultra -low Volume Flush Toilets ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [C PUBLIC No. of Building # Persons Business Activity Bedrooms Area Sgft Served [ ] Spas /Hot Tubs HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4015-1) [ PERMIT # DATE PAID FEE PAID $ RECEIPT # [ ] Temporary /Experimental DATE OF SUBDIVISION: [Section /Township /Range /Parcel No.] ZONING: ] COMMERCIAL TELEPHONE : 75 -6 e / ea For Commercial Only [ ] Floor /Equipment Drains [ ] Other (Specify) DATE: O Page 1 of ? LZ`. NCTEONS: A:=;; :;, "_CATION FOR: Check type of permit, if "Ct:er° specify type it blarlit. Al ? :?LICANT: L ropezty owner's full yam;. Telephone number for applicant or agent. ?rope:1y owner's Iegcl :y authorized reprecen:c :ive. 1: ^.:::;.°NC AD:?`'3'c.,SS: F.C. box or street, city, sty.te and zip code !railing cddrere: s c:pptic: ,:at or agent. ot, block, and subci :,so:-. let To at (recorded or ur✓mco; ° ",a-: a_: ^:vin. ). f tot is not ie. a recorded stbdivis'son, a copy oft:ze tat legal description or c'' "'d ::v'> be attached. SU37.t:V7S,',0,'?: gic; date of sub(iv :c!c.e L. :co.-ded in count; plat bao` -e (_- /c:<,, /year) or date lot c :iginany recorded. DIvidiirg on appccvr:; ::t i:io two or mom pa. :c for the purpose of conveying c_': ;rill-.: halt he considered a subdivision of the lot. .: _ic? "i'E 1r ::^_'': 2,7 e::r meter number . ".r_ e7acerty. :,:repetty rise : 0 el section/township/range/parcel number. area of a:• ~;r.._.; in acres (scraam 7catace feet) encivaivr of al: paved 'arena and prepared .ccd :seco !'Jithin public r:, c -c way or case:.1% :.c ^d c cal : ;; cf : t _ ~� !?. ::es, normally wet drainage ditches, marshes, or e:;zer such bodies of Ovate:'. Contiguous unpaved and nonco-..rate wd :;'r_ °.s-c way and easea:tents with no subsurface obatr`actione may be included in calculating lot area. 4- WA7ER SUPPLY: Check private or public. '?_zCP 1 Y ADDRESS: Street address for propes,y. For lots without an assigned street address, indicate street or road and locale in county. is 2�CI BONS: Provide detailed instructions to lot or attach an arca map showing ;c: location. :2";.P.FeDING IN.FORMAT:.ON: Gluck residential or commercial. 7.!.?'£ 'cS'q'At !SRIiMENT: 'Last type of establish_mem from Table Ili, Chapter 10D IFAC. Mean/plea: single family, single wide mobile home, restaurant, doctor's office. NC. BEDROOMS: Count all rooms des;gned primarily for sleeping and those arras expected to routinely provide sleeping accommodations for occupants. 731 E1 -DINO AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully screened patios or decks. Based on outside measurements for each. story of structure. U :PERSONS: Number of persons residing, using, or working in establishment. ]'or residential establishment, 2 persons per bedroom are assumed. BUSINESS ACTIVITY: For commercial applications only. List number of emp!oyeea, duns, and hours of operation, or other information required by Table EI, Chapter IOD -6, PAC. FDtTURES: Mark each listed fixture with number installed or "NA' if not applicable. S:4NATURE: Signature of applicant or agent. Date application one day submitt&;:i to the CP}tU with appropriate fees and attachments. T TACEt MFiiNTTS: A site plan drawn to scale, showing boundaries with eimensiorta, :ccatio:as of residences or buildings, swimming pools, recorded easements, onsite sewage disposal system component.: and lccctic -, slope of property, any existing or proposed wells, drainage features, filled arras, obet ^acted areas, and surface water. ".rscticn, of wells, onsite sewage diepoaai systems, surface waters, and othar pertinent facilities o fecturea on adjcccnt prope: :y, if '..T.te fc:. cm with 75 feet of the applicant lot. Location of any public well within 200 feet of lot. For residences, c door plan (residences) showing number of leedrorno and building area of each unit. IFor nonresidential cc ents, a fnn' olcn showing the sc,rc.e ffcata o of e es'< :5lisar:eaet, all plumbing drains and fixture types, and other fectuaes necessary :o determine composition and quartity cf wastc_vote :.