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PLUMBINGMIAMI SHORES VILLAGE, FLORIDA BUILDING 1 ELECTRICAL i! PERMIT N° 9265 PLUMBING fl Owner of Building Architect Contractor or Builder Legal Description Address of Building Lot Work to be performed under this Permit Bl. Subdi- vision Value cf Project $ DATE. ' 195 :. Contractor's License No Amt. of Permit $ , This permit is granted to the contractor or builder named above to construct the bc.ilding 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 qr specifications and that he }ssumes 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 cent, servant or employee. / >,y CONTRACTOR OR BUILDER BY AUTPIO BUILDING ELECTRICAL PLUMBING Owner of Building Architect Contractor or Builder Legal Lot Description Address of Building PERMIT N° 9299 CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA Work to be performed under this Permit Bl. Subdi- vision Value cf Project $ DATE / Contractor's License No. Amt. 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 or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or employees. BY AUTHORITY 195 • 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. BUILDING ELECTRICAL PLUMBING ROOFING Owner of • Building Architect Contractor or Builder Legal Lot Description Address of Bui:ding PERMIT N° 5006 CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE. FLORIDA DATE Contractor's License No. / Work to be performed under this Permit Bl. Subdi- vision BY AUTHORITY 195 Value of I! Amount of Project $ ; j 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 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 regulation:: 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 either, myself, my agent, servant or employee. Permit No � '' L 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 _- _ -- � - ? {✓ No. --� _ _ r -- Street- -Ili_ Lf Registered Architect and /or Engineer -- _, -- _------------------ _ - ___ - - Employing Plumber's Name' %L _ _ ,' % n, ." _ „1,_ -/%_ _._._. No.. 4. qL�_ %___ Street....- L_____ Location and Legal Descri Lot- ____.___ _ ° ___ —__ Block_ Subdivision„,_ S and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)- New Building __- Remodeling_ -- Addition________ Repairs No. of Stories. Size Septic Tank ____ Type of Tank_ — Capacity Gals. Feet of Drain .............. _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well -- _ _— ___.Size of Soakage Pit Amount of Permit $__ 7 (Signed)____ ______- _. <_.._�.�' -_ _._ Plumbing Inspector. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r” 6>MOT The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Pennanent Supplement, 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 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 under this permit, as are Homed by Miami Shores Village. Date Street STATE OF FLORIDA, COUNTY OF DADE. Q Before the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared My Commission Expires Notary Public, State of Florida Master Plumber. 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 erein by h?sr, 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 mates-ids and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY lulls URINAL8 CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CO�I LIOT Q / / // �/ � l /U CMECK ""���TUUf SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CGNTR. LIST �I "�— - -- _ CMECK Permit No � '' L 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 _- _ -- � - ? {✓ No. --� _ _ r -- Street- -Ili_ Lf Registered Architect and /or Engineer -- _, -- _------------------ _ - ___ - - Employing Plumber's Name' %L _ _ ,' % n, ." _ „1,_ -/%_ _._._. No.. 4. qL�_ %___ Street....- L_____ Location and Legal Descri Lot- ____.___ _ ° ___ —__ Block_ Subdivision„,_ S and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)- New Building __- Remodeling_ -- Addition________ Repairs No. of Stories. Size Septic Tank ____ Type of Tank_ — Capacity Gals. Feet of Drain .............. _Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well -- _ _— ___.Size of Soakage Pit Amount of Permit $__ 7 (Signed)____ ______- _. <_.._�.�' -_ _._ Plumbing Inspector. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING r” 6>MOT The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Pennanent Supplement, 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 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 under this permit, as are Homed by Miami Shores Village. Date Street STATE OF FLORIDA, COUNTY OF DADE. Q Before the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared My Commission Expires Notary Public, State of Florida Master Plumber. 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 erein by h?sr, 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 mates-ids and /or workmanship. fi Cr Permit No , ._...... Size Septic Tank_ of Tanks. Amount of Permit $ STATE OF FLORIDA, } as. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 MiaeT:i Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatien3 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 fig &Om' I) l (. / No. e 11) E _/ q � Street-. 3.egistered Architect and /or (Engineer :mploying Plumber's Name ...Sf/ .(2.4'.Fi Ci l O b No..2t/iP Location and Legal Description Lot BI pek / Subdivision.._. Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) ___ ._._... New Building — Remodeling Addition Feet of Drain Tile.____ _ — __ Dist. Feet of Tank or Drain Field from Well ...- •--- -• - - -_ _._ Nature of Water Supply: City—Well. __.__ .________Size of Soakage Pit (Signed)_ Street. Repairs No. of Stories Capacity Gals. Plumbins Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of laboa under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent £upt.lement, and lla% iv >, ;- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed ly him in ^' wcrk o b� performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice 'Xi no'icer as ae:, required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed Ica this „ °.rrui, licensed by Miami Shores Village. (Signed) --- �-Z � / — Mastn Plumber Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, peranzrfi :y uppPaire 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 brat all "accts; therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is m.de neoensary by improper notice for lfaspe e% or fruity materials and /or workmanship. CLOSETS BATH TUDe SHOWERS LAVA• TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT•Ne TOTC.L FIAYI RES CONTR. L I: CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATH! DEEP WELL SPRKLR. SYSTEM SWIM . 0 POOL . y'/ i'Flf. . : , <P M CONTR. LIST CHECK fi Cr Permit No , ._...... Size Septic Tank_ of Tanks. Amount of Permit $ STATE OF FLORIDA, } as. COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 MiaeT:i Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatien3 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 fig &Om' I) l (. / No. e 11) E _/ q � Street-. 3.egistered Architect and /or (Engineer :mploying Plumber's Name ...Sf/ .(2.4'.Fi Ci l O b No..2t/iP Location and Legal Description Lot BI pek / Subdivision.._. Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors) ___ ._._... New Building — Remodeling Addition Feet of Drain Tile.____ _ — __ Dist. Feet of Tank or Drain Field from Well ...- •--- -• - - -_ _._ Nature of Water Supply: City—Well. __.__ .________Size of Soakage Pit (Signed)_ Street. Repairs No. of Stories Capacity Gals. Plumbins Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of laboa under the Florida Workmen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent £upt.lement, and lla% iv >, ;- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed ly him in ^' wcrk o b� performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice 'Xi no'icer as ae:, required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed Ica this „ °.rrui, licensed by Miami Shores Village. (Signed) --- �-Z � / — Mastn Plumber Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, peranzrfi :y uppPaire 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 brat all "accts; therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is m.de neoensary by improper notice for lfaspe e% or fruity materials and /or workmanship. Permit No. New Building _... CONTR. LIST CONTR. LIST CHECK STATE OF FLORIDA, COUNTY OF DADE. CHECK CLOSETS SEPTIC SEWER TANK CONN. BATH SHOWERS TUes DRAIN FIELD ss. LAVA- TORIES MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is '' ereby made for the approval of the detailed statement of the plans and spec& cations 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 _ ,_ ---- -,. --- ---- - - - - -- -_ - No.__, .. Street..._. Registered Architect and /or Engineer Plumber's Name No. Street _ Location and Legal Description Lot ______________ Block Subdivision Street and Number where work is to be performed —No Street____ State work to be performed and purpose of building (By Floors) Remodeling___._ ___ _____ Addition Repairs No. of Stories _._. .. SINKS SOAKAGE GREASE PIT TRAP SLOP SINKS LAUNDRY TUBE URINALS SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM•G POOL Type of Tank Capacity Gals. Dist. Feet of Tank or Drain Field from Well Size Septic Tank- ___ - -- Feet of Drain Tile __ Nature of Water Supply: City —Well. Size of Soakage Pit \mount of Permit $ . (Signed)--------- �__.!�. Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by l>inc in the work to he 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 under this permit, as are licensed by Miami Shores Village. (Signed) CATCH BASIN FLOOR DRAIN Date _, DRINKING FOUNT'N5 My Commission Expires Notary Public, State of Florida Master Plumber. TOTAL FIXTURES Before me, the undersigned authority, a notary public, duly authorized to 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 f:ullty materials and /or workmanship. Permit No. Application is 1:ereby 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 No ___ Street Registered Architect and/or Engineer Employing Plumber's Name No. Street _ Location and Legal Description Lot Block Subdivision Street and Number where work is to be performed—No. Street State work to be performed and purpose of building (By Floors) New Building CONTR. LIST CHECK CONTR. LIST CHECK CLOSETS SEPTIC SEWER DRAIN SOAKAGE TANK CONN. FIELD PIT Amount of Permit $ STATE OF FLORIDA, I COUNTY OF DADE. BATH SHOWERS TUBS SS. Remodeling Addition Repairs LAVA- TORIES MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT SINKS GREASE TRAP SLOP SINKS Type of Tank LAUNDRY TUBS --(Signed) URINALS SOLAR HEATER DEEP WELL SPRKLR. SYSTEM ____ Dist. Feet of Tank or Drain Field from Well (Signed) CATCH BASIN SWIM' POOL Date FLOOR DRINKING DRAIN FOUNT' NS Size Septic Tank Feet of Drain Tile Nature of Water Supply: City—Well.. Size of Soakage it' Capacity Gals. No. of Stories My Commission Expires Notary Public, State of Florida TOTAL FIXTURES Vt 7 Plumbi Inspector. The undersigned applicant for this building permit does hereby certify th rstands and accepts his obligations as an Lployer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and lias 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 perfonned 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 ttre required by the Act. The undersigned agrees to employ only such sub-contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. Before me, the undersigned authority, a notary public, duly authorized to 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 workmanship. • f l 0 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date '!j l J % g Job Address 0 1 / £ Tax Folio / / 3; WO 506 10 Legal Description LOT ° GC)) ek/Y1(xzM. PQ, . Historically Designated: Yes No Owner/Lessee / Tenant ym Man S �� \ -e.__ Master Permit # 4 13 Owner's Address 05 n E q G* • Phone 096`O7 (c Contracting Co. -- (0 O U CcJL C— Address Qualifier 1 €yam State # g9 C55 LY Architect/Engineer Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL L/P UMBING ECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION 1 c Square Ft. Estimated Cost (value) ' a (J O. 00 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 -gamed contractor to do the work stated. ■ Signature of owner an or Condo sident Date Notary as to 0 s er and/or Condo Pr My Co s i, ssion Expires: i SS # - Phone r te /(0 - - 6T'(12 / Municipal # Competency # Ins. Co. - CkYr l C Address Date .�� 2 ' 19 Buildtrr ao-.a2a -< . C: L= EA MY; Co w . - . ,r--_,... � v . ^CTML�i Ii 1`Jdlf C 2 4 I ;_.,r M 7.XP. MAR. ;,22C 2 C.C.F. /- v NOTARY ,�� BOND 360 TOTAL DUE APPROVED: Zoning Building Electrical s1 / Mechanical Plumbing Engineering '/ J CONSTRUCTION PERMIT FOR: [ ] New System [ j,Existing System ( ] Holding Tank [ ] Temporary /Experimental Repair Abandonment Other(Specify) APPLICANT: AGENT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: 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. DEPARTMENT OF HEALTH 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 [ ;.1 'GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] A [ ) [GALLONS / GPI)] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K ( J GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ) D ( ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ J 'SQUARE FEET SYSTEM / A TYPE SYSTEM: [ ] STANDARD [ ) FILLED [ J MOUND [ 1 2 CONFIGURATION: ( ] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: / Z ELEVATION OF PROPOSED SYS'EA'SITE [ '.1 [INCHES/PT] [ABOVE /BELD*] BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ) [INCHES /FT] [ABOVE /BELOW} BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES 0 11 E R SPECIFICATIONS B-Y " APPROVED BY: DATE ISSUED: STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ CONSTRUCTION PERMIT RECEIPT # Authority: Chapter 381, FS & Chapter 10D -6, FAC BLOCK: SUBDIVISION: DH 4016, 10/96 (Replaces HRS -H Form 4016 [page 1] which may be used) (Stock Number; 5744 -001- 4016 -0) } A t ( SECTION /TOWNSHIP/RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] ' TITLE: TITLE: EXPIRATION DATE: CHD Page 1 of 2 CONSTRUCTION PERMIT FOR: [ ] New System [ ] System [ ] Repair [ ] Abandonment APPLICANT: PROPERTY STREET ADDRESS: LOT: BLOCK: PROPERTY ID #: SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, 2AC. REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER 2ERMITS EXPIRE ONE YEAR FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH 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 A N K D R A I N F I E L D 0 T 11 E R [ [ [ ) I GALLONS ] [GALLONS ] GALLONS GALLONS [ ) SQUARE FEET PRIMARY DRAINFIELD SYSTEM [ ] SQUARE FEET SYSTEM TYPE SYSTEM: [ ] STANDARD [ CONFIGURATION: [ ) TRENCH LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE [ ) (INCHES/FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT BOTTOM OF DRAINFIELD TO BE [ FILL REQUIRED: [ SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ CONSTRUCTION PERMIT RECEIPT # Authority: Chapter 381, FS & INCHES SUBDIVISION: DH 4016, 10/96 (Replaces HRS -H Form 4016 [page 1] which may be used) (Stock Number: 5744- 001 - 4016 -0) Chapter 10D -6, FAC ] Holding Tank [ .] Temporary /Experimental ) Other(Specify) [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:( ] / GPDJ CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] ] ] ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ ] INCHES AGENT: FILLED BED x TITLE: TITLE: ( ] MOUND [ ] [ ] EXPIRATION DATE: CHD Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tra:king number by County Health Department. 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.C. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID #: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter I0D -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 Health Department personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by County Health Department. EXPIRATION DATE: Cne year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. PY l . 4" 1 4!: - -t �� LICAPTT: : STATE a.N °s' FLORIDA DEPARTMENT OF ''EALTR 4 3) REHABILITATIVE SERVICES OPTSI 'E SEWAGE DISPOSAL SYSTEM SITE T: °VALUATION AN CIFEC TIC 75 SC<:C'. 1PROF a ;a2, IINPORMATIICLI SITE LOCK: �? 5 rIIVIISIICEZ: f 3C EATS ID p Lt 2 : / /1 \���/1 / 1 QS cPOIIIea ®L�JIDli[d No. ' i -_% CO� m;,� it �.. C017,4"): E� EZ;'�:Ci�,��, L�3 o I;�iE� „TE �..� :.JJ L,���'..OYL - » ©;,3 c4rMEL °3 (6,,1217.d1;2,10 ,,;3�G��,o .��••�1,.:�.,.�.,� :> ,,,,., -,&� MZ1, ;V 3.;,f ' C STTRATICN ,, `” E M. 2 IM `2,217, 2EC71 ZM Cif C«J't ', o ),Y , tl., ®NW �e'S JJ .. \W SIlilb PLAN: YES ' NO \% U�1�iS0U IJ CAUiY�J[�91� "J 2 -1[i l�'2� �J tl 2�7t Lr:!..1c�11` O �1'r..�. 8 I SEG8�1v�.; :;'.,..yV: a � � ., �2-� •,7•C �� :;'�:Z3 t�l�s. 3.��eL�.: �:Ciy� .., t�'� ":-� „ � g n=a:,:27to SEWAGE LCzZ: ? �° G2'LICY 2 °3 UPS? T0©0 C —Y,Q), L' e1:3 C....,A , x a ..w3:,�,y AREA AVA .:7� ':;:2,1ME: > i p..� ?}� " a ,te7� L 'J C 1�� U� �.��:;u� ;���. 1.,1.3�:.G� LZ.S �� � °o : ii '3s'eF l° R sNCE K ,T LOCATION: LoROPOSy':;D i?ZTE 3 SETE 1:2 nrtt Fin L` SET =ACK WEICZ CAN IEE CAA :.:X M:', L1 1 L z, L°'LSCLoomiL nYs :: `.t: , "I..Z,:', r, n:7-: .3 ,..i 2. \.. \ „1. , ,' -. I SFr G P22/EM g u''X'. IV Z. i_,I'C iu:2 q 2PY JT,2 S D'T MC LI;;.,(!Z,:” . , Mt ,:? ' '. T li .... • °f'e_.,:,eS : 71 7,f..C: /1,.( 7.'‘` LIMITED u2'..-?,8 _ ILL , I a ml':aia;ti o O r /) , '2 .,,: NO : ".. .! .\:.. 1 ;,' ; I,r ' .'T :SU: : :',4;;I G FOUNDATIONS ( c FT :P R"O ,S�ZTY LEYES: 2" ` "i IKV 8:viv CNW;". ;'.:3 . , :,Y..:2 o ° ;1? SW;ZZ::,f:6.7: O FREQr`I::LI'J, li'3.a"�C�1ChZECv°: :1 S�`ES � �.�L�® .i© iZ:c;r:\L.t Nv; ...=a I :70 1? .2 R i LCOD ELEVATION FOR SITE : 72 • 321, /NSI M S , L d`EYA :C0'N;: ; typal:.,( //Collor ""ezturre iIDEla�a,l tc SOXY., SERIES: U.9 A { �1 4v i ` ... � , z C:."3.2',11/:. o-�Fa �V�A�a 6/o- T�L�i °e %:, _ J 1�i �i niC�l�i� }�: `�CVv', � �I�'LUw,� �". �i�zC .V'., !;,/ o .. .. ,, :- o ��',, ,�,a.: ..v w."uu SEASON WATER nA:Su, s�`a 1..:,e:u,�G�.... �.2, °o ai.,, k- ,.➢f.cac' s 1AE1,0)1Yii :�: a:.t©t �.,.., ,. ....,v .:. N;,1 ..,• :..., : :: WATER TAEL:. VE"`v':i,TA'J;J,Osti: E 1f ES : o dC. ;.. TEXTURE/LOADING BALE FOR SYSTE .LZ : : :=: 72Ln a7FIOURAT 'CA: D THE C , A ARKS/AD =ON aY,A: 7 SIB' : -, EVALUATED BY : /, �;"< // AGED MRS -3 Form 4015, Mar 92 (Obsoletes previous editions uhich may not 'sse used) (Stock Number: 5744-003 - 40 -" p RMIIT # 7a - ,Ere.2// !1' it 2,2 S3D 1: V 1 8`3 1 .�:'n.L'S \%. " - ,.. ....� So:I1, I'aC:c ELD IIR?FC;FD:', ...'CCZ7 C,r 3 APPLICATION FOR: ]- New System ,] Repair APPLICANT: 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 NEED] LOT: `; BLOCK: PROPERTY ID #: / //. PROPERTY SIZE: ACRES [Sgft/43560] PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: 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 1OD -6, FAC ] Existing System [ " i] Holding Tank [ ] Temporary /Experimental 'A Abandonment (; J Other(Speciffy) SUBDIVISION: DATE OF SUBDIVISION: [Section /Township /Range /Parcel No.] ZONING: BUILDING INFORMATION ( ] RESIDENTIAL l 1 Garbage Grrindcrs /Disposals Ultra -low Volume L'lush Toilets No. of Bedrooms J Spas /Hot Tuba PERMIT # DATE PAID FEE PAID $ RECEIPT # TELEPHONE: [ ] COMMERCIAL PROPERTY WATER SUPPLY: [ ] PRIVATE [ PUBLIC Building # Persons 3usiness Activity Area Scift Served For Commercial Only t toor/ cuipment Dry; rs Other (Specify) APPLICANT'S SIGNATURE: ATE: ----- N3S -X Form 4015, Mar 92 (Obsotetes previous editions which may not be used) ?ago i © ff 3 (Stock Number: 5744- 001-4015 -1) Scale: Each block represents 5 feet and 1 inch = 50 feet. Notes: \-\ • • \:":" Site Plan submitted 1D1,. . Plan Approved 7 By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMit' Permit Application Number ' / , ' \ // - • ,) c, DH 4015. 10/96 (Replaces HRS-H Form 4015 which may be used) (stook Number: 5744-002-4015-6) \< / ^ , , PART II - SITE PLAN Signature Not Approved " 299 9' \ 4 , ; , - Date / • ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Title 7 County Health Department Page 2 of 3