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295 NE 95 St (2)STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISP OSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Applicant r t Number 5 3e11--3 Z' 1 51`- �� s S -� PART II - SYSTEM INSTALLATION INSPECTION AND INAL I SAL ION APPROVAL Installer /kit/ / ® ,> Proper tank legend: Yes No Tankswatertight: Yes f✓ No Proper tank outlet device: Yes ✓ No Tank Manufacturer c._,� Tank material 4CA Tank level: Yes No T /e Tanksize• /74 gallons gallons gallons Manhole or marker to grade: Yes No i�� Math Length Bed I f 43 Length Math Length width Length 2 feet x / feet — t 2 feet feet \i feet feet Length feet x feet= ft feet feet feet feet Proper No. drainlines: Yes No feet feet feet feet Proper pipe separation: Yes V No tl Total = ft Total = ft Distribution box level: Yes No s� Systems located as permitted: Yes ✓ No Systems including plumbing stub -outs installed at proper elevation: Yes No /17A 7 gy �� Average depth to drainpipe invert from finished grade: ' inches Maximum depth 2 6 Inches Average depth of drainfield gravel: inches Minimum depth of gravel ! nches Gravel is suitable quality: Yes j No Proper gravel size: Inspected by: Drainfleld Trench Yes E No Date /4' a /^U ? Approved by: Backfill or fill material required: (Quality) Yes f1 No (Quantity) Yes IV No Other findings HRS —H Form 4016, Jan 86 (Replaces Feb 85 edition which may be used) (Stock Number: 5744-002-4016-4) PART III - FINAL INSTALLATION APPROVAL AN APPROVED INSTALLATION DOES NOT ARANTE PERFORMANCE COUNTY PUBLIC HEALTH UNIT Note: Completed copies of this form will be provided to the applicant, installer and the building department. Page 2 of 2 Permit No. 1 3v5 77 Owner's Name and Address TO/f cO/ 110A!•=e Registered Architect and /or Engineer z Amount of Permit $ i5 0 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 at building during the progress of work. No. a 9sw 8 Street 9.s • �ing P/u be s n� /i° S / eAdem 1)t,4_ P1 uk D / h1� .No. D A). f - Street f , 213/2/ h�� c. o n0 ��// j 02 971 S',2ti/ ' Locatio and Legal escripti Q Block Subdivision 9 Street and Number where work is to be performed — No. J .� / 1� • (i, �� Street �� State work to be performed and purpose of buildi�Sg (By Floors N New Building Remodeling Addition Size of Soakage Pit !,.' x . X ' r r2 - Type of Tank f;4,eft Q61.3. Capacity Gals. Repairs Size Septic Tank QO Feet of Drain Tile Tank or Drain Field from Well Nature of Water Supply: City - Well (3 ?c, (Signed) Keamfrfrie c3 COUNTY OF DADE. ss. Date t �� / 0 Al//9M / d' 4 e i. No. of Stories 9oo a ,Q1, (Signed) STATE OF FLORIDA, 300 My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $25.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and/or workmanship. Plumbing Inspector 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 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be 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 the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. 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 he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. CLOSETS BATH TUBS SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNTAINS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SWIM'G. POOL CONTR. LIST 0 . CHECK Permit No. 1 3v5 77 Owner's Name and Address TO/f cO/ 110A!•=e Registered Architect and /or Engineer z Amount of Permit $ i5 0 MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 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 at building during the progress of work. No. a 9sw 8 Street 9.s • �ing P/u be s n� /i° S / eAdem 1)t,4_ P1 uk D / h1� .No. D A). f - Street f , 213/2/ h�� c. o n0 ��// j 02 971 S',2ti/ ' Locatio and Legal escripti Q Block Subdivision 9 Street and Number where work is to be performed — No. J .� / 1� • (i, �� Street �� State work to be performed and purpose of buildi�Sg (By Floors N New Building Remodeling Addition Size of Soakage Pit !,.' x . X ' r r2 - Type of Tank f;4,eft Q61.3. Capacity Gals. Repairs Size Septic Tank QO Feet of Drain Tile Tank or Drain Field from Well Nature of Water Supply: City - Well (3 ?c, (Signed) Keamfrfrie c3 COUNTY OF DADE. ss. Date t �� / 0 Al//9M / d' 4 e i. No. of Stories 9oo a ,Q1, (Signed) STATE OF FLORIDA, 300 My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $25.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and/or workmanship. Plumbing Inspector 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 5966, Compiled General Laws of Florida Permanent Supplement, and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be 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 the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. Master Plumber. 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 he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. DEPARTMENT OF HEALTH ANDh`REHABILITATIVE SERVICES . ; APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Chapter 10D -6, FAC Permit Application Number ? � '- ° "----o embalm ONseamne PART I APPLICATION Name of .Owner 4- E VA CD&.5l tic-hi Telephone Number I 90 - 7F/ • Mailing Address of Owner ' /V E. 9� , .ST , /t/ i/4114/ Ij O R es Date of Application: /0 • Owner's Agent RA1)El►'1yi 60441 9/vin -'n C. Builder Agent's Mailing Address 1 W. w' 7 7 P/7-1/6"/ g d D! � [.G H , � Telephone No Property Street Address WA' 43 F/. .33/ Lot No. • Block No` Subdivision Date Subdivided NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION This Application., is for New System Repair Existing System Type of Sewage Flow Sewage Flow Establishment (Gallons per day) Based On Type of Residential STATE OF FLORIDA ft ft2 Exact Directions to Property AUDIT CONTROL NON° 239907 Applicant's Signature HR8•H Form 4015, Feb 88 (Obsoletee previous editions which may not be used) (Stock Number: 8744. 001.4018-1) TOTAL FLOW = y r •• � _ j G ., a�1 , ' 1 '-i.j''4Y'rVIA , i i'771, 4r • Authority: Chapter 381, FS No. Bedrooms Heated or Cooled Area No. Dwelling Sewage Flow (each dwelling unit) (each dwelling unit) Units (Gallons per day) Page 1 of 3