DRAINFIELDf .RMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address ; aos N. E. 7' /y 57.
Legal Description oX 1'o<4 / � ia Master Permit #
Owner / Lessee / Tenant YeYIS WOEL
Owner's Address / B S /u.E . ? S S T 4 phone ' 7S?'— 2 9 49
Contracting Co. 4 (6 (L Address o? / j ] /4�G//Q /v , 46 364;
Qualifier 4 a/024 SS# /35 - 3V - 05 phone 92/L/
State# CFc 0 AC $ / S
Architect /Engineer —' Address
Bonding Company Address
Mortgagor — Address
Permit Type (circle one): BUILDING ELECTRICAL (PLU MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION O,cl4UN FI el-19
Square Ft. 2D®
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. 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 com•liance with all applicable laws regulating construction and 2 n
Furthermore, I a.thori a the above -named contractor to d the work stated.
S3 &KaLft an /or Condo Pre
�i
L � NOTARY PUBLIC, STATE OF FLORIDA. / ° °1
MY COMMISSION E YPI! +,ES: Sept. 29, 1995.
BONDED THRU NOTARY PUBLIC UNDERWRITERS
Notary as to Owner and /or Condo President
My Commission Expires:
* * * *
PERMIT FEE: APPROVED:
Zoning
Mechanical
Competency# Ins. Co. ON F(LE
NOTARY PUBLIC, !" !•.•• rE OF FLORIDA.
MY COMMISSION I' :•. !(;S: Sept. 29, 1995. //
BONDED THRU NOT,�K; :'! BLIC UNDERWRITERS. / (ufF
Notary as to Contractor or Owner - Builder
My Commission Expires:
* * * * * * *
Fire
Estimated Cost
■
Date:
Tax Folio // . q21 J5/ 307® g°
Other
Electrical
Engineering
Signature of Contractor or Owner- •Buifde +
* * *
Notes:
Site Plan submitted by
r x� a f T�✓ 4I :� F <. � �F� ,t jv Jt
STATE OF FLORIDA
�. ti
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
PART II - SITE PLAN --------------- ------------- ------- --------------
------ - - - - --
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SIGNATURE
Plan Approved
By County Public Unit
B ALL C NGGLES,MU T BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
HRS -H Form 4015, Feb 8 (Obsoletes previous edition h ich may not b- used)
(Stock Number. 5744- 002 - 4015 -6)
Not Approved
Permit Application Number
TITLE
Date
Page 2 of 3
AMP
CIINCEEN Tallahassee. jgpt, 1175339
F
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
O
Authority: Chapter 381, FS
Chapter 100-6, FAC
Date of Application / 9 Permit Application Number
- - -- PART 1 — APPLICATION
Name of Owner in ye x5 Nocac Telephone Number 7 re Z94
Mailing Address of Owner /° r NE q5" 57
Owner's Agent 4 (o v-p
Builder
Agent's Mailing Address 2 (/ 7 h1 /wi a40 '.3d6 Telephone No 9Y6_2 Zoo
f*►
Property Street Address /AV s NC 9' S-' 5 T .
Lot No. Block No Subdivision Date Subdivided
NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND B UNDS DESCRIPTION
This Application is for: New System Repair ,Existing System
Type of Sewage Flow Sewage Flow
Establishment (Gallons per day) Based On
TOTAL FLOW =
Type of No. Bedrooms Heated or Cooled Area No. Dwelling
Residential (each dwelling unit) (each dwelling unit) Units
ft
Sewage Flow
(Gallons per day)
9 -2 S ft2 / 3oa
Exact Directions to Property
All 302127 Applicant's
(17 D
HRS-H Form 4015, Feb 85 (Obsoletes previous edition which may not be used)
(Stock Number: 5744-001 - 4015-1)
Page 1 of 3