482 NE 93 St (2)Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
❑ �°
n PERMIT N° 13665
..DING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
1
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 cr 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 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 responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
Work to be performed under this Permit
Bl.
Subdi-
vision
Value of
Project $
DATE 195
Contractor's
License No
Amt. of
Permit $
BY AUTHORITY
PROPERTY ID #:
•
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE
ONSITE SEWAGE DISPOSAL SYSTEM
h CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
D [,/ ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET
A TYPE SYSTEM:
Y CONFIGURATION:
[OR TAX ID NUMBER]
PERMIT #
SERVICES DATE PAID
FEE PAID $ �� •c
RECEIPT # /' ! j
COMSTRUCTION PERMIT OR:
f ] New System [i. ] Existing System ] olding Tank [(j Temporary /Experimental
] Repair [/V Abandonment [J&Other(Specif
APPLICANT AGENT: t)
PROPERTY STREET ADDRESS: a&--2 /7/ /��' ��✓ � � .
LOT: d ? � Ll BLOCK: /I�� SUBDIVISION:
O , / 6/A . _
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
19oI0
3,
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.
SYSTEM DESIG .Np SpE)'IFICATIONS
. ' , /d' mow;
•
T [ei /C4 [GALLQNrS / GPD SEPTIC TAN: AEROBIC UNIT CAPACITY MULTI-CHAMBERED/IN SERIES:
A [ ] [GALLONS / GPD] CAPACITY MULTI CHAMBERED /IN SERIES:[ ]
N [ ] GALLONS GREASE INTERCEPTC)R CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
SYSTEM
[ ] STANDARD [ ] FILLED [ ] MOUND
[ ] TRENCH BED [
[
N
F LOCATION OF BENCHMARK: ' Ue 7'J , 4 f . (6-45 C)v -7
I ELEVATION OF PROPOSED SYSTEM SITE [ 0] cINCHE PT] [ABOV E BENCHMARK
E BOTTOM OF DRAINFIELD TO BE [ V(' NCHES FT] [ABOXgTBEtoWLRENCHMARK �REFERENCE
D FILL REQUIRED: [
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED /4_
L !
] INCHES EXCAVATION REQUIRED:
TITLE:
TITLE:
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
exocumnEnNockmagum
] INCHES
if
CPHU
- >+
EXPIRATION DATE:62 (7�,
Page 1 of 2