Loading...
SEPTICSTATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Applicant £3-i1 4,9 P7 76 Parmit Numbeerr -2- 5/m ,v- c . / 3 S i -� 0 ?0 - PART II - SYSTEM INSTALLATION INSPECTION AND FINAL INSTALLATION APPROVAL Installer / t 1 � • �+.� ✓� m.v c c �2, Proper tank legend: Yes NV/a No Tank material c c-rdA Tank level: Yes No Tanks watertight: Yes •v /. No Tank size: gallons gallons gallons Proper tank outlet device: Yes N/a' No Manhole or marker to grade: Yes �thlo Drainfield Trench Absorption Bed Length Width Length Width Lengthy '.r feet x / 0 feet V ft feet feet , 1 p5 feet feet Length feet x feet = — ft fee': feet j feet feet Proper No. drainlines: Yes fro fee feet feet Proper pipe separation: Yes No Total Total = ft Total = ft Distribution box level: Yes No 7ii . /0/ Systems located as permitted: Yes ti No Systems including plumbing stub -outs installed at proper elevation: Yes No A Average depth to drainpipe invert from finished grade: � inches Maximum depth _� Inches Average depth of drainfield gravel:_ inches Minimum depth of gravel L inches Proper gravel size: Yes ✓ No Gravel is suitable quality: Yes '/ No Backfill or 911 material as required: (Quality) Yes —iJ No Other findings: Inspected by: V.q -j /_ 1 –c c'6/7 �'-e C') Date /4 PART III - FI N APPROVAL Date 1 4- frapproved by: 1 ' '4" COUNTY PQBe HEALTH UNIT p AN APPROVED I N P y • LATION D S ES NOT GUARANTEE PERFORMANCE Note: Completed copies of this form ill be provid •d to the applicant, installer and the building department. Tank Manufacturer N/ (Quantity) Yes No HRS—H Form 4016, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744. 002. 4016.0) Page 2 of 2 Air MIAMI SHORES VILLAGE, FLA. N9 5823 JOB ADDRESS <CY FL c. INSPECTION / 9 9 tfe TIME READY REMARKS • INSPECTOR DATE e Permit ?''o " c? ?.1 Date —1 — , ( 1 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 Address _-- -___ -I '.. _�a! !`-! __ ----- --- --- No._ ` — / 1 ' ..... " - - - - -. Str / !.1 . Registered Architect and /or Employing Plumber's N Location and Legal Description Lo Street ard Number where work is to be performed—No State work to be performed and purpose of building (By Floors) New Building----- -- - - - - -- --- Remodeling -- -- MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT h2 3 4 •.l Street-` Blorti Subdivtsi E str eet - Addition Repairs No. of Stories : . —_-_- Type of Tank _ Capacity Gals ....... Feet of Drain Tile_ i _ e ls/_ —Dist. Feet of Tank or Drain Field from Well Nature of Water Sup y: City— Well._-___-__ ....... _ ....... _____-------- - - - - - _ -- - Size of Soakage Pit Size Septic Tank_____ Amount of Permit $ -- (Signed).:-.1.6) Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obh ations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bus emn- plied wit i 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 work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed ygder this peen ;R, as are licensed try Miami Shores Village. STATE OF FLORIDA, COUNTY.' OF DADE. (Signed)_ Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me wel 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 bv him stated are true. My Commission Expires Notary Public, State of Florida aster Plumber. 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 TUBS BATH TUBS S LAVA TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT'NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL CONTR. 1.1 VT —!— CHECK e Permit ?''o " c? ?.1 Date —1 — , ( 1 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 Address _-- -___ -I '.. _�a! !`-! __ ----- --- --- No._ ` — / 1 ' ..... " - - - - -. Str / !.1 . Registered Architect and /or Employing Plumber's N Location and Legal Description Lo Street ard Number where work is to be performed—No State work to be performed and purpose of building (By Floors) New Building----- -- - - - - -- --- Remodeling -- -- MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT h2 3 4 •.l Street-` Blorti Subdivtsi E str eet - Addition Repairs No. of Stories : . —_-_- Type of Tank _ Capacity Gals ....... Feet of Drain Tile_ i _ e ls/_ —Dist. Feet of Tank or Drain Field from Well Nature of Water Sup y: City— Well._-___-__ ....... _ ....... _____-------- - - - - - _ -- - Size of Soakage Pit Size Septic Tank_____ Amount of Permit $ -- (Signed).:-.1.6) Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obh ations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and bus emn- plied wit i 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 work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed ygder this peen ;R, as are licensed try Miami Shores Village. STATE OF FLORIDA, COUNTY.' OF DADE. (Signed)_ Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me wel 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 bv him stated are true. My Commission Expires Notary Public, State of Florida aster Plumber. 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.