271 NE 95 St (9)Permit No. . `‘
Amount of Permit = 10
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
ffw
Size Septic Tank_ -Type of Tank__
Feet of Drain Tile Dist- Feet of Tank ar Drain Field from Well. .._.__..
(Signed
�s sr-
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 it
building during progress of work. q �✓�
Owner's Name and Address ....V _;.' a; eb4L No. ,- / Street. f rte'
Registered Architect and /or Engineer
Employing Plumber's Nal
// Lo ad o r n and L egal I es on �' 4'1
Street and Number where work is to be performed —No ! `_ Streets "' �.��_..C.�...
y _.
State work to be performed and purpose of building (By Floors)___: .. 'a.zr ` _ - ::...1..
New Building.._..._ _ _.._.........._.. Remodeling —_ ____._— Addition.. _
f SubdivWon. S_
(Signed) _
Plumbing Inspector.
Nature of Water Supply: City —Well. Size of Soakage Pit.
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 5998, Compiled General Laws of Florida Permanent Supplement, and liar corn-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wort ao 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 t}ie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed and •• permit, xs are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, 6
COUNTY OF DADE.
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 be has carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will he Scads whoa web sI•bspeotb b m.de by improper notice for inspecttbn, or faulty
materials Sad /cr worlanaoship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA.
TORIES
SINK[
SLOP
SINKS
LAUNDRY
TuvS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N[
TOTAL
•IIITUR[S
Comm
LIST
CHECK
—
_
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
0
TRAP
SOLAR
HEATER
DEEP
WILL
SPRKLR.
SYSTEM
SwIN'
POOL
GONTR.
LIST
CHECK
Permit No. . `‘
Amount of Permit = 10
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
ffw
Size Septic Tank_ -Type of Tank__
Feet of Drain Tile Dist- Feet of Tank ar Drain Field from Well. .._.__..
(Signed
�s sr-
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 it
building during progress of work. q �✓�
Owner's Name and Address ....V _;.' a; eb4L No. ,- / Street. f rte'
Registered Architect and /or Engineer
Employing Plumber's Nal
// Lo ad o r n and L egal I es on �' 4'1
Street and Number where work is to be performed —No ! `_ Streets "' �.��_..C.�...
y _.
State work to be performed and purpose of building (By Floors)___: .. 'a.zr ` _ - ::...1..
New Building.._..._ _ _.._.........._.. Remodeling —_ ____._— Addition.. _
f SubdivWon. S_
(Signed) _
Plumbing Inspector.
Nature of Water Supply: City —Well. Size of Soakage Pit.
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 5998, Compiled General Laws of Florida Permanent Supplement, and liar corn-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the wort ao 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 t}ie Act. The undersigned agrees to employ only such sub- contractors, on work to be performed and •• permit, xs are
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, 6
COUNTY OF DADE.
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 be has carefully read the foregoing application, and that be did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will he Scads whoa web sI•bspeotb b m.de by improper notice for inspecttbn, or faulty
materials Sad /cr worlanaoship.
Inspected by
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM - CONSTRUCTION AND INSTALLATION PERMIT
Applicant G ' -e n✓lye_ 1 / T P r it Number
e 6
PART II - YSTEM INSTALLATION INSPECTION AND PINAL INSTALLATION APPROVAL
S
Installer /4M/ / / N 'G -e`C
Proper tank legend: Yes i No
Date ° 14 Approved by:
Tanks watertight: Yes c No Tank size: gallons gallons gallons
Proper tank outlet device: Yes No Manhole or marker to grade: Yes 0/ No
Drainfield Trench Absorption Bed
S
Length Width Length Width Length a n ° ‘eet e x I� ' feet �ft
aQ
feet feet ^ feet feet Length feet x feet= ft
/
feet feet /" feet feet Proper No. drainlines: Yes
feet feet feet feet Proper pipe separation: Yes
Total = ft / Total = ft Distribution box level: Yes No
Systems located as permitted: Yes
0
Tank material
Tank Manufacturer
Systems including plumbing stub -outs installed at proper elevation: Yes
Average depth to drainpipe invert from finished grade: a inches Maximum depth 2 Inches
Average depth of drainfield gra el• J inches Minimum depth of gravel /c inches
Proper p gravel � quality: Pro ravel size: Yes No Gravel suitable ualit : Yes V No
Backfill or fill material as required: (Quality) Yes No (Quantity) Yes Ce No
Other findings:
AN APPROVED INSTALLATI
HRS—H Form 4016, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4016-0)
PART III - F N TALLATION PROVAL
Tank level: Yes IJb No
N DOES NOT GUARANTEE PERFORMANCE
P COUNTY PURL H EALTH UNIT
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
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