280 NE 95 St (11)Date 4/22/96
Legal Description Historically Designated: Yes No
Owner/Lessee / Tenant Master Permit # 3 ��
Owner's Address
Contracting Co. NORTH DADE SEPTIC TANK Address 800 NW 111 STREET, MIAMI 33168
Queer DENNIS NEVILLE SS# Phone 751 -7676
State # 025836 -8 Municipal # Competency # 12842 Ins. C 'RAVELERS /ESIF
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): IKEINAMEXKLUMaigi PLUMBING }j1AK t fAkXtfNtk X ` RXkkKtf9FxX §kXNX
WORK DESCRIPTION INSTALL DRAINFIELD
Square Ft. 300
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 1. t all work will be done in compliance with all applicable
actor to d•.,,1, work stated.
laws regulating construction and zoning. Furthermore, I authorize the above -n
of o and/
Aga
sir Cont.
Si
:Wi : 0 I lk
Not..' as to Owner . •
• y Commission . -
FEES: PERMIT
APPROVED:
Zoning
Mechanical
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Job Address 280 NE 95 STREET Tax Folio
JURIST
r Condo President
RADON
Building
4 /73/1 C
Date
23 qb
o President Date
tK % wAtttttttttttttt , "%t4,tmtwm.t. ,
�o ��v P n ° Tei J. Feldcr �`
c....-41e', Ii Public, 5 :c:. of Y7ar fia •:
yr 1 v 1 Pj a VV. �lIri y 3 . i. 1 1` e . Cv ; !!;;Q7 <
.()F WI Aiy CcirLn :oa 17: :p1:;,3 G/?!) .
C.C.F.
Estimated Cost (value)
f Con actor or 0 ner- Builder
Notary ; s to Contrac .r • •
ission E , sires
Ter a I. Feldd
oar �.�. ' Not.Sy 1 t„
.. n�.C:; :., ,17 'a
> c� s a Cam:'. ✓: 5.;')) � F�J7 �� l f 1�Q74::' "-' "'•� y�
1.800 -3 -1-: VAY- F.%YU :.y• ".•r
s£.nac Co. ?�
TOTAL DUE
;5V NOTARY
Phone 757 -7328
Electrical
to 0
Builder ate
96
Date
Plumbing 'U V 'U,Q ' 1� /t/1✓ �}4 Engineering
APPLICANT: JURIST
LOT: BLOCK:
PROPERTY ID #:
A
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
CONSTRUCTION PERMIT FOR:
[N] New System [ Existing System [ ;y] Holding Tank [ N ] Temporary /Experimental
[ Y ] Repair [ N ] Abandonment [ Other(Specify)
PROPERTY STREET ADDRESS: 280 NE 95 STREFT, 33138
SUBDIVISION:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
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. 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.
T
A
N
K
D
R
A
I
N
F
I
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L
D
0
T
H
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R
SYSTEM DESIGN AND SPECIFICATIONS
EXISTING
9UU ] [ GALLONS / VW] 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]
] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
[ 300
[
] SQUARE FEET
] SQUARE FEET
TYPE SYSTEM:
CONFIGURATION:
LOCATION OF BENCHMARK: FN'R 1(L 11
ELEVATION OF PROPOSED SYSTEM SITE [ ]
BOTTOM OF DRAINFIELD TO BE [ 6;, II ]
FILL REQUIRED: [
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:V.. Z
Va A! ( DRAINFIELD SYSTEM
SYSTEM
[X ] STANDARD [ ] FILLED [V] MOUND
0.._] TRENCH [ XJ BED
] INCHES
[ CHE/FT]
/FT]
EXCAVATION REQUIRED:
INSTALL 12" OF LOAMY COARSE SAND UNDEh BOMM
OF DRAINFIELD SUBNIT DENCHMARK BEFORE INSI'EC"TIO' .
THIS PERMIT IS NOT FOR ADDITIONS.
INVERT ELEVATION (MINIMUM: ' 0
1s(Yi"i'OI°i OF DRAINFIELD ELEVATION (MINIMUM) :c /•
AGENT: NOR''h DADE SEPTIC TANK
TITLE:
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001- 4016 -0)
INSTALLER /CONTRACTOR
[ABOVE /
[ABOVE/
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
TITLE: --Z
SEPTIC TANK SHALL BF PUMPED AND A SOLID
EFLECTION DEVIL: INSTALLED 0: THE OUTLET TEE.
[ ‚J ]
INCHES
BENCHMARK
BENCHMARK/
;4 x - /1/1
POINT
POINT
CPHU
EXPIRATION DATE: 7 2
Page 1 of 2
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
Notes:
Site Plan submitted by :'
•
Scale: Each block represents 5 feet and 1 inch = 50 feet.
PART II - SITE PLAN
d.d
..l .i . ).l..i
SIGNATURE
PlarfApproved
a t
r
Not Approved
By
ALL CHANGEWMUST BE AIP BY THE t~dUNTY PUBLIC HEALTH UNIT
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4015-6)
TITLE
Date C
County Public Unit
Page 2 of 3