145 NE 95 StPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Job Address 145 NE 95 STREET Tax Folio
) Folio 1/ ,,I? /j R 7 *) J. >
Legal Descriptio
419
� / /&ter Permit # JQPV
n
Owner / Lessee / Tenant JOHNSON
Owner's Address 145 NE 95 STREET, MIAMI SHORES 33138
Contracting Co. NORTH DADE SEPTIC TANK
Qualifier
State# 025836 -8
Architect /Engineer
Bonding Company
Mortgagor
PERMIT FEE:
DENNIS NEVILLE
SS#
phone
Ins. Co. MARYLAND CASUALTY
Other
Electrical
754 - 3375
Mechanical Plumbin l /S3 ` ylrng"ineer ing
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
'ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT
Authority: Chapter 381, FS
Chapter 10D -6, FAC
Applicant Permit Number
PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL
Treatment Tank
Minimum Draintrench OR Minimum Absorption
Size Bed Size
Septic tank or Grease
aerobic unit gallons interceptor gallons Square Feet Square Feet
Septic tank or
aerobic unit gallons Dosing tank gallons Square Feet Square Feet
Graywater
tank gallons Square Feet Square Feet
Laundry
waste tank _ gallons Square Feet Square Feet
Other Requ'
(a) Installation must be in accord with requirements of chapter 10D -6, FAC.
(b) A system construction permit is valid for a period of one calendar year from date of issue.
(c) Final installation inspection and approval is required before the system is covered.
(d) Invert of stub -out for to be benchmark.
Invert of stub -out for to be benchmark.
Invert of stub -out for to be benchmark.
Invert of stub -out for to be benchmark.
(e) Fill quality and quantity:
(f) Other:
System design and specifications by Title
Construction authorized by: Date
County Public Health Unit
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL NO
HRS -H Form 4018, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number,5744 -001-4016 -0)
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