1994 DRAINFIELDPERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 6/23/94 Job Address 1260 NE 94 STREET Tax Folio
Legal Description
Owner / Lessee / Tenant KORNBLUH Master Permit # 7S
Owner's Address 1260 NE 94 STREET,MIAMI SHORES 33138
Contracting Co. NORTH DADE SEPTIC
Qualifier DENNIS NEVILLE
Phone 754 -3375
State # 025836 -8 Municipal # Competency # 12842 Ins.Co. TRAVELERS
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION INSTALL DRAINFIELD
300 SQ FT Estimated Cost(value)$1300.00
Phone
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 - truction and zoning. Furthermore, I
authoil a the above- name co rector to do the work stat
Signature of Contractor or Owner- Builder
Date:
ry as t oS•n r = ctor or Owner- Builder
M Con Connialini i' egg; FLORIDA AT LARCE
MY COMMISSION EXPIRES JUNE 19, 1993
* *
BONDED TNRU NUCRLEISEt* A AIS%IATES
* **
NOTARY TOTAL DUE 11
Fire Other
Zoning Buildin: Electrical
Mechanical Plumbin:. :/h Engineering
CO STRUCTION PERMIT OR:
CO
New System Ejv ] Existing System ] Holding Tank 0] Temporary /Experimental
[ y ] Repair [ ] Abandonment [ ] Other(Specify)
APPLICANT: ( ` ,^ /^ I v AGENT: 61( "4 , •
ll I\ �!� 1 `CJ ���'lll
PROPERTY STREET ADDRESS: /2 6 Ale q4
LOT:
PROPERTY ID #:
SYSTEM DESIGN AND SPECIFICATIONS
R
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
BLOCK: SUBDIVISION:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
gdrl1z.F
PERMIT #
DATE PAID 6 -
FEE PAID $ 4 D o
RECEIPT # G cOd
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
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.
] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
] 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 [ a�] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ � ] SQUARE FEET
A TYPE SYSTEM: [ ] STANDARD [
I CONFIGURATION: [ ] TRENCH
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [ ] INCHES
SPECIFICATIONS BY:
APPROVED BY:
SYSTEM
] FILLED
BED
( T ) 1:v4.0 (1 104" -„zu., 0.43-c,440 o 1,4„, j
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
, TITLE:
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 - 0)
APPLOCAMT
[ ] MOUND [ ]
[ ]
EXPIRATION DATE: ID_Z `7
CPHU
Page 1 of 2
LOT: BLOCK:
STATE OF FLORIDA`, ` PERMIT #
DEPARTMENT OF HEALTIOAND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
AGENT:
SUBDIVISION: -
[Sect$on /Township /Range /Parcel No. or Tax ID Number]
KORNBLUH
PROPERTY ID #: 1260 NE 94 STREET
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: [ ]
TOTAL ESTIMATED SEWAGE FLOW: 450
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE: 300
BENCHMARK / REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
SOIL PROFILE INFORMATION SITE 1
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: 74FT DITCHES /SWALES: - -- FT NORMALLY WET? [ ] YES [ ] NO
WELLS: PUBLIC: 1004FT LIMITED USE: - -- FT PRIVATE: --- FT NON - POTABLE: --- FT
BUILDING FOUNDATIONS: 6.2 FT PROPERTY LINES: 8.2 FT POTABLE WATER LINES: 15 FT
• SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ ] NO
10 YEAR FLOOD ELEVATION FOR SITE: 6.0 FT MSL /NGVD
Munsell # /Color Texture
BROWN SANDY
USDA SOIL SERIES:
0"
Depth
to 72"
to
to
to
to
to
to
to
to
OBSERVED WATER TABLE: INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: - 10 INCHES [ ABOVE / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [`Y YES [ ] NO MOTTLING: [ ] YES [X] NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: ) DEPTH OF EXCAVATION:
DRAINFIELD CONFIGURATION: [ ] TRENCH [ X4 BED ( ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
HRS -H Form 4015, Mar 92 (Obsole
(Stock Number: 5744 - 003 - 4015 -1)
r
evious editions which ' maa! not
YES [ ] NO NET USABLE AREA AVAILABLE: ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE)
SQFT UNOBSTRUCTED AREA REQUIRED: 300 SQFT
[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
u
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture Depth
BROWN SANDY 0" to 72"
4� N to
-.- to —
to
to
to
�\to
USDA SOIL SERIES:
NORTH DADE SEPTIC TA/ 0
T 7 7 .
10 YEAR FLOODING? [ ] YES [ ] NO
SITE ELEVATION: 8.2FT MSL /NGVD
01/
r ti f 4
INCHES
DATE: 6/23/94
Page 3 of 3
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PROPERTY STREET ADDRESS:
APPLICATION FOR:
[N ]'New System
[y ] Repair
APPLICANT: KORNBLUH
AGENT:
MAILING ADDRESS:
LOT: BLOCK:
PROPERTY ID #:
PROPERTY SIZE:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
1 Unit Type of
No Establishment
1 SFR
2
3
4
APPLICANT'S SIGNATURE:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMI
Permit Application Number
PART II - SITE PLAN
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERV±CES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION
Authority: Chapter 381, FS & Chapter 10D -6, FAC
[N ]
[N ]
Existing System
Abandonment
NORTH DADE SEPTIC
(74 Garbage Grinders /Disposals
[gj Ultra -low Volume Flush Toilets
Holding Tank
Other(Specify)
800 NW 111 STREET, MIAMI 33168
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 DEED]
ACRES [Sgft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [XX] PUBLIC
SUBDIVISION:
1260 NE 94 STREET, 33138
[XX] RESIDENTIAL
No. of
Bedrooms
3 BEDROOMS
HRS -H Form 4015, Mar 92 (Obso(etes- previous_editions which may not be used)
(Stock Number: 5744-001-4015:1)
DATE OF
[Section /Township /Range /Parcel O
[ ] COMMERCIAL
Building # Persons
Area Sgft Served
e
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
TELEPHONE: 893 -8272
754 -3375
DATE: 6/23/94
Temporary /Experimental
Business Activity
For Commercial Only
Spas /Hot Tubs [ Floor /Equipment Drains
Other (Specify) s �
Page 1 of 3
PROPERTY STREET ADDRESS:
APPLICATION FOR:'
[N J,New System [N ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
[y ] Repair [ ] Abandonment [N ] Other(Specify)
9
TELEPHONE: 893 -8272 ,
754 -3375
APPLICANT: KORNBLUH
AGENT:
MAILING ADDRESS: 800 NW 111. STREET, MIAMI 33168
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 DEED]
LOT:
PROPERTY ID #:
PROPERTY SIZE:
BLOCK:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
1 SFR
2
3
4
y" Garbage Grinders /Disposals
[gJ Ultra -low Volume Flush Toilets
APPLICANT'S SIGNATURE:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABIy.ITATIVE SERV±CES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION
Authority: Chapter 381, FS & Chapter 10D -6, FAC
NORTH DADE SEPTIC
SUBDIVISION:
1260 NE 94 STREET', 33138
[XX] RESIDENTIAL
No. of
Bedrooms Area Sgft Served
3 BEDROOMS
HRS -H Form 4015, Mar 92 (Obsofetes- previous editions which may not be used)
(Stock Number: 5744-001-4015:1)
Spas /Hot Tubs
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
[ ] COMMERCIAL
[id
DATE: 6/23/94
Building # Persons Business Activity
For Commercial Only
DATE OF
IO N.
[Section /Township /Range /Parcel No.J ONING:
ACRES [Sqft /43560] ' PROPERTY WATER SUPPLY: [ 1 PRIVATE [XX] PUBLIC
Floor /Equipment Drains
Other (Specify)
Page 1 of 3
4.
Notes:
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMI
Permit Application Number
OLD SYSTEM OVERFLOWING.
Site Plan Submitted by:
Plan Approved
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 002 - 4015 -6)
PART II - SITE PLAN
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KORNBLUH o 1260 NE 94 STREET. 33138
SIGNATURE
Not Approved
TITLE
Date /0 c7
�
�' �- County Public Unit
ALL CHANGES MUST BE APPROVED BY TH COUNTY PUBLIC HE UNI '
s
Page 2 of 3
HUILDING
FF1ECTRICAL
?LUMBING
ROOFING
Owner of
wilding
'.rchitect
ontractor t
1r Builder
.egal Lot
iescription
address of
luilding
MIAMI SHORES VILLAGE. FLORIDA
❑ PERMIT N° _ 3227
0
CONTRACTOR OR BUILDER
Work to be performed under this Permit
f •
B1
Subdi-
vision
Value of Amount of
Project $ Permit $
BY AUTHORITY
DATE « 195 "
Contractor's
License No. / J
This permit is granted to the contractor or builder named above to construc the building or to install the equipment or device described in the application
ierefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans,
lrawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
ime 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
:ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
ertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifications and that he assumes responsibility for work
one by his agents, servants or employees. r�
Signed . ' BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered here Oder in compliance with all ordinances and regulations
ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
r. �'i
BUILDING ❑
ELECTRICAL ❑
MIAMI SHORES VILLAGE. FLORIDA
PLUMBING PERMIT N° 9702
ROOFING ❑
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Address of
Building
Lot
CONTRACTOR OR BUILDER
Bi.
Work to be performed under this Permit
Subdi-
vision
DATE
Contractor's .;
License No
Sq. Ft
Value of
Project $
Ai
Amt. of
Permit $ G.
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 • !'', g
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.
BY AUTHORITY