707 NE 93 St (3)Date /r1 -9 ,5 Job Address -.2 d? A/ 93 ST
Legal Description ze'7 .23 ../2 -02.2 42, 4.5
Owner Lessee / Tenant / i ENO C J J /9t / / 2 /? 1
Owner's Address 70 7 X(F.' q3 S 7
Contracting Co. ECCJNO
Qualifier
G6v/,f %�i v ccalfi
State # Municipal #
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN ne
WORK DESCRIPTION 'JO /N riet /frcZ
Square Ft. .2
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 's accurate and that all work will
be done in compliance with all applicable laws regulating cons ;. ion and zoning. Furthermore, I
authorize the :bov- 'hed contractor to do the work stated.
Notar
My
**
FEES: PERMIT :v
APPROVED:
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
sSa
/irafr
Condo President
as to. Owner and /or Condo President
MOWNLEfnielii
State of Florida
My Coma,. END. 11/''
BOND
* * * * *
Competency # Ins.Co.
Tax Folio
Date:
/OS- SSc;2-
7
Phone - 7SO -
Master
Permit #
AddressOJ33 (Uk (Z 57
- - Phone
Esti mated Cost(value) /a o
Signature of Contractor or Owner- Builder
Notary as to Contractor or Owner- Builder
Ci Expires: 11-
-3-53'3
,State of FHo e
* * **
RADON C.C.F.V NOTARY TOTAL DUE ' 0;0
Fire Other
Zoning Building Electrical
Mechanical Plumbin l' 5 �ineering
APPLICANT: `1 tt // Ai C
LOT:
PROPERTY ID #:
SITE EVALUATED BY: ,
STATE OF FLORIDA , ,
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK: SUBDIVISION:
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [4
YES [ ]
TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS
AUTHORIZED SEWAGE FLOW: nfa GALLONS
UNOBSTRUCTED AREA AVAILABLE: 00 SQFT
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS /"
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
WELLS: PUBLIC:
SURFACE WATER: FT DITCHES/ WALES: FT NORMALLY WET? [ ] YES }``N0
FT LIMITED USE: A/6 FT PRIVATE: /44- FT NON- POTABLE* FT
BUILDING FOUNDATIONS: ) 57 FT PROP RTY LINES: '22.,_ FT POTABLE WATER LINES: >e<_, FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING? [ ] YES [`'
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color Texture Depth
to )
771 to
USDA SOIL SERIES:
to
to
to
to
to
to
AGENT: 004)6 >c - �
PERMIT # � . � � /
SOIL PROFILE INFORMATION SITE 2
DATE: »1 / X ,/ , /
[Section /Township /Range /Parcel No. or Tax ID Number]
NO NET USABLE AREA AVAILABLE• ACRES
PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA REQUIRED: 4/46 SQFT
[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
Munsell # /Color Texture Depth
to
to
to
to
to
to
to
to
to
USDA SOIL SERIES:
OBSERVED WATER TABLE: ) 18 INCHES [ABOVE //BELOW EXISTING GRADE. TYPE! [PERCHED / APPARENT
ESTIMATED WET SEASON WATER TABLE ELEVATION: 67 INCHES [ ABOVE /BELOW) EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [01 OTTLING: [ ] YES [ DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: J11( DEPTH OF EXCAVATION: INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [X] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
HRS-H Form 4015, Mar 92 (Obs•letes previous editions which may not be used) Page 3 of 3
(Stock Number: 5744-003- 4015 -1)
, , •-• '••••_.•
BENCHMARK SITE I SIJE 2
E SHOT:
H.I. 1 SH07.' : 91•I'a.'.'
/
SETE 3
SHO
H.11.
.. • ,
- - • •-• ••••• : 7:1.
• :•.•••.-'•-• • • ::; -..••••. • - ' .
• ; C 7
a 3.: _ • ; 7
T NS: >Z/\ ::c
:y?c.
eocins
STi EVAlf..TJA071F..n evziuttor, tit, c. dt:tc; ceci a!I sza:•;mitted.
DEPARTMENT OF EHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PtrRMIT
Permit Application Number +
PART II - SITE PLAN
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
'Stock Number: 5744- 002 - 4015 -6)
Plan Approved Not Approved
11-
Notes: I,&.o '
04 �; �. JG l tad 6 /oc oc'F
1v19- 4t „fur via >1'6 i %4)
Site Plan Submitted by
SIGNATURE
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
TITLE
Date 4 1
County Public Unit
Page 2 of 3
APPLICATION FOR:
[ ] New System
[ ] Repair
AGENT:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APP ICOTION FOR C9WSTIWCT ON PEEMIT j ,,
A hOi'ity C) a" t, r Y'81?' PS 'Qbapter 10D -6, °FAC
[ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
[ ] Abandonment [ ] Other(Specify)
APPLICANT: / z r /tii 24 0
F(\ Ao o C c i
MAILING ADDRESS: 1%.
3 b() , , 7 -
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: BLOCK: SUBDIVISION:
PROPERTY ID #:
PROPERTY SIZE: ,J(, ACRES [Sqft /43560]
1
2
3
4
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
e )3 7;7,4 y
[ ] Garbage Grinders /Disposals
[ ] Ultra -low Volume Flush Toilets
APPLICANT'S SIGNATURE:
R ri r ' if 9
[ j/] RESIDENTIAL
Unit Type of No. of
No Establishment Bedrooms
Building # Persons
Area Saft Served
/c '; 0
NRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4015 -1)
[ ] Spas /Hot Tubs
[ ] COMMERCIAL
PERMIT #
DATE, PAID
FEE'PAID $
RECEIPT -#
DATE:
TELEPHONE: 73 Gs J 7
DATE OF
SUBDIVISION:
[Section /Township /Range /Parcel No.] ZONING:
PROPERTY WATER SUPPLY: [ ] PRIVATE [ PUBLIC
Business Activity
For Commercial Only
[ ] Floor /Equipment Drains
[ ] Other (Specify)
Page 1 of 3
INSTRUCTIONS: —111111111pIPPIPr--
.
1 :?•ilopcity n•nvor .1.7.711'.:.
To" r.policcra c. nnu.o.o.
AGENT': 1 rr Luthot
• - • 'Z."; : rfn..• :2:2plientont
ro• or commercial.
o. .„ . . . n. ...„ . ,,,,, ). 1,• . •:. col)y
- .71.U.FIZ
7 : ": 7 o . • . .
ti. • • cc:: Coi•; • o
r • :: .•
• •
.•'' . 3
11.• • .• ... let t".•
." Checic nr;v: nr
Strcct cddr, xoporty. *For lot:3 s: ;:nc.i.cate sonoot or road f.nd loccle il countv.
D IC N Hs.• .ictinas to lot c ,• :o: location
: typo o 7com TabiG 7. - ternpin ;.inp:!..n. . n
do. tor's
NO. :3:1EDICIO1. . • ' • acconmodations for
occupants.
BUILIDINC :Total :ontroo, or - 1 - •:osed or-or of ern•cflos uoit. 't •
•.: F11, or open or Fully
;.croorncti rion-:•surto. for Lech stuL; .
1?S-1SONS: XL' C.)! "L") iirj using, or - .7)c:tins , el•tz.blisl ft . p.:FiOn5 :L'
!ISSUMed.
131.15: A : rpplicEtions only. Yi. of cr• shifts, ,
;:11;1•131,:.1
JD-5, YitC.
a rz zh 1X ill' number instali,n!; c: if not r :
' 07 :Tont. Da - : :2 s•
'•, ! ;n
en.ls!te :cwt. *.: ,.. .rr„ r
c•nl.tor Eri) Ifirl 7: It .. Lot lot. no of
public viol'. 7C3 lot of Int.
an:.; bu iin s-en of ect..11 FOf
nstabliZrirne.ri.•:, 7 11: j!/hi 13 ncio CPA fixtui 1y c, apt
feotut y to :I.:tell ‘4netnwnt.cr.
LOT:
0
T
H
E
R
Repair
APPLICANT:
CONSTRUCTION PERMIT FOR:
[ ] New System [ ] Existing System
[
PROPERTY STREET ADDRESS:
PROPERTY ID #:
STATE OF FLORIDA
] Abandonment
BLOCK: SUBDIVISION:
SYSTEM DESIGN AND SPECIFICATIONS
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [ ] INCHES
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: 4 ,„ :) ., co
CPHU -White Applicant- Canary
PERMIT # rj ' / /,/ 0
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ ,ter
CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
[ ]
[
0 0 (,1 0 14 I •Z, 4 IAGENT :
7 `7 i
Holding Tank [ ] Temporary /Experimental
Other(Specify)
E ("0 TZ (3,7'
[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 [ ] [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 [ IJt / � / ) ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH BED [ ]
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001-4016
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
TITLE:
Fl
EXPIRATION DATE:
Installer /Contractor -Pink Building Department - Goldenrod
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 # 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.