PLUMBINGBUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
ROQFING ❑
w er of
Building
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 4822
Architect
Contractor � . t
or Builder le:; - a - + � • •
Legal Lot /
Description lI Bl
Address of
Building ! - .? w �f
i
done by his agents, servants or employees.
CONTRACTOR BUILDER
Work to be performed under this Permit
Subdi-
vision
Value of
Project $
BY
DATE / =
Contractor's
License No.
u
Amount of
Permit $
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
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 responsibilit 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 state its or specifications and that he assumes responsibility for work
Signed"' r l f l k ' ' �` BY
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 ac-
cepting this permit I assume responsibility for all work done by ei)her, myself, my agent, servant or employee.
7 t
-6
195 5 '
AUTHORITY 90;
Permit No. __ d 7__V
Amount of Permit $ /i
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herew' i ubmittg for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordina 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 progress of work.
Owner's Name and Address No Street
Registered Architect and /or Engineer __l_!__
/ /� a �
Employing Plumber's Name __L7 /2"' I �i� t s '. i _ No 188 3 }'_ Street__P__ ? /
Location and Legal Description Lot —_ Block Subdivision_
and Number where work is to be performed —No. a .2 !1' c ; ' Street _ __
State work to be performed and purpose of building (By Floors)
New Building '--- Remodeling Addition Repairs No. of Stories
Size Septic Tank 2 '° , Type of Tank Capacity Gals.
Feet of Drain Tile__ ,L_P Y7. " t Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City -Well Size of Soakage Pit
_ (Signed
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that h understands and accepts his oblig (i s as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied 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.
/ C.
}
(Signed)_ Yez
STATE OF FLORIDA, r
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 he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
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
CHECK
Permit No. __ d 7__V
Amount of Permit $ /i
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herew' i ubmittg for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordina 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 progress of work.
Owner's Name and Address No Street
Registered Architect and /or Engineer __l_!__
/ /� a �
Employing Plumber's Name __L7 /2"' I �i� t s '. i _ No 188 3 }'_ Street__P__ ? /
Location and Legal Description Lot —_ Block Subdivision_
and Number where work is to be performed —No. a .2 !1' c ; ' Street _ __
State work to be performed and purpose of building (By Floors)
New Building '--- Remodeling Addition Repairs No. of Stories
Size Septic Tank 2 '° , Type of Tank Capacity Gals.
Feet of Drain Tile__ ,L_P Y7. " t Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City -Well Size of Soakage Pit
_ (Signed
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that h understands and accepts his oblig (i s as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied 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.
/ C.
}
(Signed)_ Yez
STATE OF FLORIDA, r
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 he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Permit No. ___ a 7. 7
Application is Hereby made for the approval of the detailed statement of the plans and specifications herew)'submi(d for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordina e 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 progress of work,
Owner's Name and Address__ No._ __ 6.2- 4StreeL 4
Registered Architect and /or Eng
Employing Plumber's Name l',j No 't 1 l 1 L Street._ z_ ``
Location and Legal Description Lot Block__
Street and Number where work is to be performed— No. ___ 6 .2
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs _ No. of Stories
_Type of Tank
Dist. Feet of Tank or Drain Field from Well
Nature of Water Suppll: City7Well _ Size of Soakage Pit
Size Septic Tank
Feet of Drain Tile
Amount of Permit $__
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
The undersigned applicant for this building permit does hereby certify that hinderstands and accepts his obli ions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)_ f$--- "�
Plumbing Inspector.
Street
Date
Capacity Gals
My Commission Expires Notary Public, State of Florida
Subdivision
Master Plumber.
STATE OF FLORIDA, I
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 he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
•
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
f��
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
/,I♦ •
• •
TOTAL
FIXTURES
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL.
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Permit No. ___ a 7. 7
Application is Hereby made for the approval of the detailed statement of the plans and specifications herew)'submi(d for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordina e 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 progress of work,
Owner's Name and Address__ No._ __ 6.2- 4StreeL 4
Registered Architect and /or Eng
Employing Plumber's Name l',j No 't 1 l 1 L Street._ z_ ``
Location and Legal Description Lot Block__
Street and Number where work is to be performed— No. ___ 6 .2
State work to be performed and purpose of building (By Floors)
New Building Remodeling Addition Repairs _ No. of Stories
_Type of Tank
Dist. Feet of Tank or Drain Field from Well
Nature of Water Suppll: City7Well _ Size of Soakage Pit
Size Septic Tank
Feet of Drain Tile
Amount of Permit $__
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
The undersigned applicant for this building permit does hereby certify that hinderstands and accepts his obli ions as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
(Signed)_ f$--- "�
Plumbing Inspector.
Street
Date
Capacity Gals
My Commission Expires Notary Public, State of Florida
Subdivision
Master Plumber.
STATE OF FLORIDA, I
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 he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
•
BUILDING
ELECTRICAL
PLUMBING
Owner of
Building'
Architect
Contractor
or Builder
Legal
Description
•
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORID
PERMIT N? 8074
Work to be performed under this Permit 4 -'/ �'
Lot
Subdi=
vision
Building of ,1 / 7 , ,, ,� r � I Value of
g ..• t 4.'r Project
1
DATE ,,tt��
Cd( tractor
License No.
Amt. of
Permit I1 /
BY AUTHORITY
194
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 appli-
cation herefor in strict compliance with all ordinances pertaining thereto and w th 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 respon-
sibility for work done by his agents, servants or employees.
�4• �
signed. B
-c� .
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform tl{b ork covered hereunder in compliance with all ordi ti and regulation
pertaining thereto and in strict conformity with the plans, drawings, statements r specifications submitted to the proper authoifititts of Miami ShotsZlOge,
In accepting this permit I assume responsibility for all work done by either myself, my agent, servant or employee.
Xt41 6-44 et)
BUILDING A
ELECTRICAL
PLUMBING
Architect
Contractor
or Builder
Legal
Description
Lot
CONTRACTOR OR BUILDER
MIAMI SHORES VILLAGE, FLORIDA
PERMIT N° 8077
License No.
Work to be performed under this Permit r <.
Owner of _ 0
Building —
„of !e
Bl.
Subdi-
vision
DATE e
f
Cot tfactor's 1'
AUTHORITY
194 ,
Address of ./"1 ( Value of Amt. of
Building is , ' i y I, " < � n t Project Permit .- y �
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device dfscribed in the appli-
cation 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 m ay 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 respon-
sibility for work done by his agents, servants or employees. -
Signed: t /'
s x
gn ; - . w �. .- . . By .
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform 4116 ork covered hereunder in compliance with all ordifiance6 and regulations
pertaining thereto and in strict conformity with the plans, drawings, statemenfs o fffff f specifications submitted to the proper autho jes of Miartii Shores Village,
In accepting this permit I assume responsibility for a work done by eithgs myself, my agent, fervant or employee. N 9 .'] 5 .
By'
+
Permit No
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 progress of work.
Owner's Name and Address
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE. j
L, t9 ` 114
Registered Architect and /or Engineer
Employing Plumber's Name .e th ..
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size Septic Tank_ rr . - -_ i __ _._Type of Tank_
Feet of Drain Tile.___ - � c --Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well __— -------- _ - - - - -_ __ _...Size of Soakage Pit
( Signed )
Capacity Gals.
- — (steed)- - 6;51 -_.. _•� _
7z
3 C 7 -- Street-.. .,e 9 � "
Street.. Al. W L1
Location and Legal Description Lot- Black
Subdivision____ — .
Street and Number where work is to be performed —No .:_....
State work to be performed and purpose of building (By Floors)_. _.._.__. •----- _--------- __._._ New Building —. Remodeling___ - - .--- ._.— _ - -_ -- Addition.. ._• -.-_. Repairs No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli :;irons as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and has com-
plied 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 . 1 to be performed under this permit, as are
licensed by Miami Shores Village.
rir
Mast umber.
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 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 $L00 will be made wheel such re- inspection is made nsoesary by improper notice for inspection, or faulty
materials and/or workmanship.
CLOSETS
BATH
Tuns
SHOWERS
LAVA-
TORIES
SINKS
SLOP
aim('
LAUNDRY
TUNIS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONK.
DRAIN
F IELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
N
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'S
POOL
Co. NTR
r-
LILT
CHICK
+
Permit No
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 progress of work.
Owner's Name and Address
Amount of Permit $
STATE OF FLORIDA, 1
COUNTY OF DADE. j
L, t9 ` 114
Registered Architect and /or Engineer
Employing Plumber's Name .e th ..
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Size Septic Tank_ rr . - -_ i __ _._Type of Tank_
Feet of Drain Tile.___ - � c --Dist. Feet of Tank or Drain Field from Well
Nature of Water Supply: City — Well __— -------- _ - - - - -_ __ _...Size of Soakage Pit
( Signed )
Capacity Gals.
- — (steed)- - 6;51 -_.. _•� _
7z
3 C 7 -- Street-.. .,e 9 � "
Street.. Al. W L1
Location and Legal Description Lot- Black
Subdivision____ — .
Street and Number where work is to be performed —No .:_....
State work to be performed and purpose of building (By Floors)_. _.._.__. •----- _--------- __._._ New Building —. Remodeling___ - - .--- ._.— _ - -_ -- Addition.. ._• -.-_. Repairs No. of Stories
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obli :;irons as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and has com-
plied 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 . 1 to be performed under this permit, as are
licensed by Miami Shores Village.
rir
Mast umber.
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 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 $L00 will be made wheel such re- inspection is made nsoesary by improper notice for inspection, or faulty
materials and/or workmanship.
Amount of Permit S
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ."''' rr,MIT
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 progress of work. II // ���
Owner's Name and Address C_ _._ (N ; _ DA v -S 3
- •---- -•_ -.. No _‘ 2 fit'
_ e- Street. FS I E'
Registered Architect and /or Engineer_.___-_ ..—___..__ ___ - _______. _ -__ —.
Employing Plumber's Name 8 I- O ° _ / r s Sfi L . % ✓ / r• / et- C O No. ..- D ". 4
Street.._ S fE4 ,..
Location and Legal Description Lot._. ______________________.______ Block_ Street and Number where work is to be performed —No — Air
STATE OF FLORIDA, 1
COUNTY OF DADE. j
(Signed)
(Signed).
State work to be performed and purpose of building (By Floors ) _.
New Building ___ . ___ Remodeling_____ __._ Addition Repairs No. of Stories.
Size Septic Tank _________ of Tank
Feet of Drain Tile._ _- .__Dist. Feet of Tank or Drain Field from Well _.._
Nature of Wat Supply: City — Well.__ W � _Size of Soakage Pit 3
7s --• C ° S Z- - —
Date ! —
Capacity Gals
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 bus com-
plied 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be perfo e• under this permit, as are
licensed by Miami Shores Village.
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.
My Commission Expires Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of 51.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA
TORIES
I
SINKS
SLOP
SINKS
LAUNDRY
TUpS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' N5
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
[/ Q e
7 / '/
`
�
CHECK
Amount of Permit S
Permit No
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING ."''' rr,MIT
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 progress of work. II // ���
Owner's Name and Address C_ _._ (N ; _ DA v -S 3
- •---- -•_ -.. No _‘ 2 fit'
_ e- Street. FS I E'
Registered Architect and /or Engineer_.___-_ ..—___..__ ___ - _______. _ -__ —.
Employing Plumber's Name 8 I- O ° _ / r s Sfi L . % ✓ / r• / et- C O No. ..- D ". 4
Street.._ S fE4 ,..
Location and Legal Description Lot._. ______________________.______ Block_ Street and Number where work is to be performed —No — Air
STATE OF FLORIDA, 1
COUNTY OF DADE. j
(Signed)
(Signed).
State work to be performed and purpose of building (By Floors ) _.
New Building ___ . ___ Remodeling_____ __._ Addition Repairs No. of Stories.
Size Septic Tank _________ of Tank
Feet of Drain Tile._ _- .__Dist. Feet of Tank or Drain Field from Well _.._
Nature of Wat Supply: City — Well.__ W � _Size of Soakage Pit 3
7s --• C ° S Z- - —
Date ! —
Capacity Gals
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 bus com-
plied 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 tlie Act. The undersigned agrees to employ only such sub- contractors, on work to be perfo e• under this permit, as are
licensed by Miami Shores Village.
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.
My Commission Expires Notary Public, State of Florida
Master Plumber.
NOTE: A re- inspection fee of 51.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials and /or workmanship.
Plumbing Permit
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305- 795 -2204 Permit Number: PL2004 -306
Printed: 11/3/2004
Applicant: MICHAEL BROWN
Owner: BROWN MICHAEL
JOB ADDRESS: 362 NE 95 ST
Contractor AMERIGAS PROPANE AND SUBSIDIARIES Contractor's Address: 10052 NW 89 AVENUE
Local Phone: 305 - 883 - 8600
Parcel # 1132060136070
Page 1 of 1
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 4 & 5 BLK 45 LOT SIZE 100.000
Fees: Description Amount
FEE2004 -10816 Building Fee $140.00
FEE2004 -10817 CCF $0.60
FEE2004 -10818 Technology Fee $3.50
FEE2004 -10819 Training and Education Fee $0.20
FEE2004 -10820 Scanning Fee $3.00
Total Fees: $147.30
Total Fees: $14.7
Total Receipts: $ r O
Permit Status: APPLIED Permit Expiration: 4/24/2005 Construction Value: $500.00
Work: SET 200 TANK ALONE GRID AND
Signed: (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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
r rRECEIIVED
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204 OCT 2 6 2004
Date / Job Address Tax Folio ~•'- --
Legal Description n Historically Designated: Yes No
Master Permit #
Phone e6'5 a
Owner /Lessee/Tenet if r1 -76 / l Vt q
&
Owner's Address
Contracting Co. (21-41-W1 Address
Qualifier /��� 1W7-. SS #�
J4"4195 Q (v 6 8
L-- 9(0001`1
State #
Municipal #
loos Ai 1444
Competency # Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS 850.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
MECHANICAL ROOFING
Permtt Type (circle one): BUILDING ELECTRICAL PLUMBI
WORK DESCRI'TION:
Square Ft. Estimated Cost (value) e
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 ANY 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 all disciplines.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Furthermore, I authorize the above named contractor to do the work stated.
(o--1 4
Signature of owner and/or Condo President Date
Notary as to Owner alid/or•to
My Commission Expires,
FEES: PERMIT h/O RADON
APPROVED:
Zoning Building
Mechanical Plumbing
C.C.F
W•_ //-
Signature f Contractor or Owner Builder Date
Date Notarys to"Contra�cor
a etrOwner Builder Date
My Con m Sjon >j
,te
!, c-t
`, NOTAIIY4. BOND
TOTAL DUE
Electrical
Structural Engineer
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date lII
Type Insp'n n S I
Permit No. l ` v -[ 36(0
Name 6ro
Address S61 f t c15 s
Company° r 900
/ 1
w-r
sir,
iF �
Phone #
Inspection Date I
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date `, 5
Type Insp'n �d A� ( F�/� ppQx.Lii
Permit No. 1
Name 6ip
Address 3(02_ (A Cc q s f
Campany ' /
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
Date
Type Insp'n
Permit No.
Name
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
os ® 3o(
Y,A)z2
Address
Company c -0-Iu Ch'"?
Phone #
Inspection Date
• MIAMI SHORES VILLAGE
A BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
Date
Type Insp'n 1)AAP Cl'ets2)
Permit No. C.. 0 3o(
Name )
Address 2 69 &.
Company 0 4
Phone #
Inspection Date
Approved
Correction
Re- Insp'n Fee
DETERMINE NORTH
. % 1
��►
•V -`d/
AmeriGas, LPG 00899
10052 NW 89 Ave., Medley, Fl 33178
Tel. 305 - 388 -8600 Fax 305 -884 -5891
JOB: LCt ev@ ( r e r)
DATE: •
REVISED:
SCALE:
DRAWN BY:
APPROVED BY:
AFFIDAVIT:
This installation shal comply with NFPA 54, NFPA 58,
as well as all state & local codes and regulations.
GENERAL SITE PLAN
I Page of
• •
Signature of Qualifier n
PRINT NAME: �-- p(xlcT Ar itto,J
Qualifier ft L PC co Scl q
Sworn to and subscn'bed�tk e4�iis'lc
- Nino
day of DCA ,- ,,'P .
`,, ��
q B •, e
t , ?,
**. . ;li I A ' o C t . . . . . 4,, ;;
•
1� ?
V
Personally known : %.,
`' ,°
or Produced Identification:
' of identification Produced:
-
•
qpI
i todepi020-- 14- t em, to w,
tb 642 Zo PI
1 0 �6Ad U n also e" % t)
f 7
■ QG�Ca
eLG
— 17443k_ !tit re.9(U 26.-U
cD-Q
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 7/7/2004
Applicant: MICHAEL BROWN
Owner: BROWN MICHAEL
JOB ADDRESS: 362 NE 95 ST
Parcel # 1132060136070
Signed:
(INSPECTOR)
Plumbing Permit
Permit Number: PL2004 -194
Contractor KENDALL PLUMBING CO. INC. Contractor's Address: 6910 S. W. 75 TERRACE
Local Phone: 305 - 662 -8863
Page 1 of 1
Permit Status: APPROVED Permit Expiration: 1/3/2005 Construction Value: $2,000.00
Work: REPLACE KITCHEN AND BATHROOM FIXTURES, 1 KITCHEN SINK, 1 DW, 3 LAVATORIES, 1 SHOWER PAN, 1 TUB, 2 WATER
Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 4 & 5 BLK 45 LOT SIZE 1&000
N
Fees: Description Amount
FEE2004 -6797 Building Fee $200.00
FEE2004 -6798 CCF $1.20
FEE2004 -6799 Training and Education Fee $0.40
FEE2004 -6800 Technology Fee $5.00
Total Fees: $206.60
Total Fees: $ 0 40
Total Receipts: $0.00
IS 6, 4
K7
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
Ft
BUILDING
PERMIT APPLICATION
FBC 2001
Permit Type (circle): Building Electrical
Tenant/Lessee Name "1..) / /4
Contractor's Company Name
Contractor's A ddress elf
City G1 VY1
Qualifier
Code Enforcement $
Total Fee Now Due $
(Continued on opposite side)
Miami Shores Village
..; ti �� Department
' 1 n v enu-, Miami Shores, Florida 33138
�t q � T l (31)17,95.2 04 Fax: (305) 756.8972
Owner's Name (Fee Simple Titleholder) % Phone #
Owner's Address Nl l -- `lrbu. '3 /
City ! f 2 .S State
Job Address (where the work is being done) 36 2 l`.'
City Miami Shores Village County Miami -Dade
Is Building Historically Designated YES NO
Architect/Engineer's Name (if applicable) Phone #
ire.)
$ Value of Work For this Permit & - X Square Footage Of Work:
Type of Work: ❑Addition ❑ Alteration ['New JL Repair/Replace ❑ Demolition
Describe Work: i- IC I jj C t 'fiC %her -1 hcd (✓oCC`'Yl - k1 - tiv-e S
t - K f S � j D c:�: 3 C J) A-1 t✓ S 15 t-k, � � C- P � TU 6 2 �.�:I-
CCv 1 r I cE fAA ie. G1. 0vx) EC C)IJ
Submittal Fee $ b'cu.# 1sic) Permit Fee $ CCF $ /1 oR. 0 CO /CC
Notary $ Training/Education Fee $- [) Technology Fee $S • 0 0
Scanning $ Radon $ Zoning Bond $
/S 6_
Phone #
State L_ Zip 3:3 ILA 3
Structural Plan Review. $
Permit No. A I- c?-a, —
Master Permit No.
Mechanical
Zip 3 e
Phone # U ��
Zip
' - 626
Roofing
z ` Si.3623
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
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 construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
The foregoing ins
APPLICATION APPROVED Y:
Chc 12/15/03
wner or Agent
nt was acknowledged before me this
day of , 20 _ , by
Signatur ma
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLK 1. (` `t (2) G t e,� ` . c " --- - - 1
Sign: Sign: 7 Racnai 0 Chohonis
j et 0 N . Rath* 0 Choke*
nt: Commission 00320417
Print: 4 My aaa w
Commission uusz17 1 Expires June , e, 2008
My Commission Expires: N « AO Expires June 18, 2008 My Commission Expires:
(Certificate of Competency Holder)
State Certificate or Registration No. , Certificate of Competency No.
Contractor
The forego' g instrument was acknowledged before me this='
day of "\e-- ,20,by
* * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** * * * ** * * *; ****************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Y r Plans Examiner
Engineer
Zoning
Date Time
Type Insp'n
/ ,A_
Permit No.
Name
Address
Company
Phone #
For Inspect
Approved
Correcti
Re -Insp
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Building Inspection Request
MIAMI SHORES VILLAGE ( Age
BUILDING DEPARTMENT
305- 795 -2204
B
II
ilding Inspection Request
Date n 1-1 �
Type Insp'n 1 0 I
Permit No. P t 04- ' q q
Name tOm
Address
Company
Phone #
36?-NE gS SI
Inspection Date / 1
Approved
Correction ❑
Re -Insp' n Fee ❑
MIAMI SHORES VILLAGE
BUILDINI DEPARTMENT
305- 795 -2204
Building Inspection Requ
Date
Type Insp'n , I
Permit No. L., 0 ll ) 9 `J
Name ti/NN
Address 3-4 c C , cts,41-
Compan
Phone# 3 OS Z
Inspection Date
Approved
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPAR M
305- 795 -2204
Building Inspection Reques
Date ( 11 l l C T
.Type Insp'n ROu41 OdVIA P, etM5
Permit No. ` �- 4 9004 — (9 tc
Name
Address 3 (a Q5 sr
Company
Phone # 505 640d -4 8
Inspection Date 91 a Ib1/41
Approved
Correction
Re- Insp'n Fee
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
10050 N.E. 2nd Avenue • Miami Shores, Florida 33138.305- 795 -2204
Date 3 Job Address 4 r 1 -- , 12 0
Legal Description /� ���,,
Owner /Lessee/Tenet t' /�%��
Owner's Address
3 2_/gypq- 5/r 4L
Contractin Co.
Qualifier
State # e?a -''o 7 Municipal #
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
ELECTRICAL PLUMBING
Permit Type (circle one):
WORK DESCRIPTION:
Square Ft. } aaa
Historically Designated:
66(2 club
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 ANY 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 all disciplines.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws
regulating construction and zoning. Furthermore, I authorize the above named contractor to do the work stated.
Signature
11.4.e
wner and/or
ondo President
S ea ,
vole
' :te
III/110u;
/
ot� to Ow
My Commissio
ate
xpiles
. •
FEES: PERMIT ��
r
IMP
C.C.F
Tax Folio
Master Permit # �i oZ CJiR R /
° 1 f
Address J z�J54)w / 6•1
ss# / " Phone" ‘1P—
Competency # Ins. Co.
MECHANICAL
L;
Estimated Cost (value / O
7
fietEN 2:G -cL7 t903
Yes No
ROOFING
- i lA
i of Contractor ti ''r - (//1//0
Z.- ' 1
a i
Date �y as to ContrStor dt s B Date
My Commission Ex e6,
e
NOTARY 0 BOND 0 0. U
APPROVED: TOTAL DUE3 a / 1 0
Zoning Building / Electrical
Mechanical Plumbing Structural Engineer
Date
N
F
I
E
L
D
STATE OF FLORIDA.
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [
[ X ]Repair [ ]Abandonment
APPLICANT: Goldstaub, Helen
400
PROPERTY STREET ADDRESS: 362 NE 95 St Miami FL 33138
LOT: 4
BLOCK: 45 SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3206 - 013 -6070 [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ]Gallons SEPTIC TANK
A [ 0 ]Gallons
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @
D [ 200 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED
I CONFIGURATION: [ N ]TRENCH [ N ]BED
LOCATION TO BENCHMARK: Finished Floor of Existing Res.
ELEVATION OF PROPOSED SYSTEM SITE [ 1.1 ] [ FEET
BOTTOM OF DRAINFIELD TO BE [ 4.1 ] [ FEET
FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED:
OTHER REMARKS:
Existing 900 Galllons Septic Tank TO REMAIN.
Install 100 Square feet Drainfield .
Invert Elevation of the Drainfield to be NLT 7.7' NGVD.
Bottom Elevation of the Drainfield to be NLT 7.2' NGVD.
This Permit is not for addition.
SPECIFICATIONS BY: Andre, Paul
APPROVED BY: Andre, Paul
DATE ISSUED: 3/20/02
AGENT: WALLACE P, Ponder Wallace
7 °1F SE)'' is TAW SHALL NENE
TITLE:
fiEFL CT ®N DEVICE INSTALLED
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
Elev. 10.2' Ngvd
[ 36.0 ] INCHES
CENTRAX #: 13 -SG -12235
DATE PAID:
FEE PAID : $
RECEIPT .
OSTDSNBR : 02 -0842- -R
]Holding Tank [ ] Innovative Other
]Temporary [ NA ]
MULTI - CHAMBERED /IN SERIES: [Y )
MULTI - CHAMBERED /IN SERIES: [Y ]
[0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
[ N ]MOUND [ N ]
[ N ]
] [ BELOW BENCHMARK /REFERENCE POINT
] [ below BENCHMARK /REFERENCE POINT
J �
'1 -vO4tIO
TITLE: Professional Engin Dade CHD
D m , . 1 ,e '')
-- STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGEEDISPOSAL SYSTEM CONSTRUCTION PERMIT _
._. P P erm it • Appl Number ;.9, .
PART II - SITEPLAN
Scale: Each block represents 10 feet and 1 inch = 40 feet.
MOW
s
Site Plan submitted
Plan Approved
By
empases
enema
DH 4015, 10/96 (Replaces HRS-H Form 4015 ich may be used)
(Stock Number. 5744-002 - 4015 -6)
Not Approved
4 �e
ALL CHANGES s JUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
Dat� 52O ° 0
County Health Department
Page 2 of 4