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PLUMBINGPerini. Nv..2 D._7. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT A1 is hereby made for the approval of the detalled statement of the plans and specifications herewith subrat' .'1 for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mia ! Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regplatic - of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec flcatlons must: be kept at wilding during progress of work. . 7 � , , , ;Nynex... Name and Address. / __... .egist!red Architect and /or Engineer :mploying Plumber's Name . )1-4 6, .-___. No q b Street._ 2 � d' c N .27 e � , . �' Street :�fY�+ A,.. 3 . _I. Location and Legal Description Lot. Bloch Subdivision.._..._. . Street and Number where work is to be performed —No 4 2- 0 it'll pp C 2/.5 Street State work to be performed and purpose of building (By Floors) 1. ..... _.. ... _____ ..... _ '• New Building Remodeling Addition g-- _--- _.____..- • ... ........... g� _ ._ Repairs No of Stones .Type of Tank— Capacity ^ Ads. Size Septic Tank_. Feet of Drain Tile.._ - -- - --. —Dist. Feet of Tank or Drain Field from Well .......--- . - - -- _ - -_... Nature of Water Supply: City — Well.______._.._- _- ___. - - -- — _._Size of Soakage Pit Amount of Permit $ ' itr The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an endicyet of tafK» under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent fupi lement, and ha% oo z. bed with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in • Is I rk c' performed under this permit; and will post or cause to be posted' for inspection on the site of the work such pnbl; notice ): no icer rs a' requ}red by the Act.. The undersigned agrees to employ only such sub- contract work to be performed 's this licensed by Miami Shores Village. STATE OF FLORIDA, u. COUNTY OF DADE. d ( si __.1-s ... .. ... My Commission Expires Notary Public, State of Florida Plumbing Inspector Masts, Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per our; • . ppearet. 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 ti•1at all acts therein by him stated are true. NOTE: A re- inspection fee of 11.00 will be made when such re- Inspection is mede•neoesaary by Improper notice for Inspert!on. clr faulty materials and /or workmanship. CLOSETS BATH TUB[ SHOWER• LAVA• TORIES SINK• SLOP SINKS LAUNDRY TUSS URINALS CATCH imam FLOOR DRAIN DRINKING FOUNT'N• (y�r6 /J , , y�G�, r TOT•-.L FIETI RES CONTR. LI'T .2... G� q / _ -�• i / -' --- CHECK 1. 0 ' 9 RI 3 4 - �. 1 % / SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT 0 TRAP SOLAR M Darr WELL SPRKLR. SYSTEM SWIM'O POOL , ,:, : 1.'!; ( .P �,•� ; .1 ts t :1 y T M �..,. i lV* 44'7 2- I„ �_��� _ I _ I _ �j, / ,�.... �... .� .., 1) . CONTR. LIST i • CHECK 1.x,1 ;16 Perini. Nv..2 D._7. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT A1 is hereby made for the approval of the detalled statement of the plans and specifications herewith subrat' .'1 for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mia ! Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regplatic - of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec flcatlons must: be kept at wilding during progress of work. . 7 � , , , ;Nynex... Name and Address. / __... .egist!red Architect and /or Engineer :mploying Plumber's Name . )1-4 6, .-___. No q b Street._ 2 � d' c N .27 e � , . �' Street :�fY�+ A,.. 3 . _I. Location and Legal Description Lot. Bloch Subdivision.._..._. . Street and Number where work is to be performed —No 4 2- 0 it'll pp C 2/.5 Street State work to be performed and purpose of building (By Floors) 1. ..... _.. ... _____ ..... _ '• New Building Remodeling Addition g-- _--- _.____..- • ... ........... g� _ ._ Repairs No of Stones .Type of Tank— Capacity ^ Ads. Size Septic Tank_. Feet of Drain Tile.._ - -- - --. —Dist. Feet of Tank or Drain Field from Well .......--- . - - -- _ - -_... Nature of Water Supply: City — Well.______._.._- _- ___. - - -- — _._Size of Soakage Pit Amount of Permit $ ' itr The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an endicyet of tafK» under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent fupi lement, and ha% oo z. bed with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed 1 y him in • Is I rk c' performed under this permit; and will post or cause to be posted' for inspection on the site of the work such pnbl; notice ): no icer rs a' requ}red by the Act.. The undersigned agrees to employ only such sub- contract work to be performed 's this licensed by Miami Shores Village. STATE OF FLORIDA, u. COUNTY OF DADE. d ( si __.1-s ... .. ... My Commission Expires Notary Public, State of Florida Plumbing Inspector Masts, Plumber. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, per our; • . ppearet. 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 ti•1at all acts therein by him stated are true. NOTE: A re- inspection fee of 11.00 will be made when such re- Inspection is mede•neoesaary by Improper notice for Inspert!on. clr faulty materials and /or workmanship. CLosrra B ATH T UBB SMOW[R• LA VA. TORIES SINKS SLOP SINKS LAUNDR TUBA URINALS CATCH BASIN FLOOR DRINKING DRAIN RCUNT'NB To7,.L FIETI R[S CONTR. LIT - CHICK .�� SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER °EEP WELL SPRKLR. SYSTEM SWIN•O POOL A.H...■ - I -- I CONTR. X LIST _ - - r - I _� CHICK .........Z............... State work to be performed and purpose of building (By Floors)_ New Building . ......__ X Amount of Permit $. STATE OF FLORIDA. } sa, COU1r'TY OF DADE. Remodeling MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Perini. No... al . .i.2- Date ... 6/2/80 i P11�.It„ II i, llereby made for the approval of the detailed statement of the plans and specifications herewith subr r• .'l for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Mi.:- t Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulatic — of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and spec fications mar: be kept at wilding during progress of work. `.hvner's Name and Address BILL P I N G No _^ 420 N• E• Street 9 STREET .egist+ red Architect and /or Engineer imploying Plumber's Name O r NEAL SEPTIC TANK CO. N 8350 N. W • - street 56TH STREET Location and Legal Description Lot. Bloat street 95TH STREET_ Street and Number where work is to be performed —No.__ 420 N.E. Addition Repairs size Septic Tank__.. — ......... 10 5 ___ _ Type of Tank — SEPTIC Feet of Drain Tile.__ 400 SQ • _ET s._ _—Dist. Feet of Tank or Drain Field from Well. ..._..._...____ — .__. Nature of Water Supply: City — Well..___ — _ -.__— ..__..______...Size of Soakage Pit capacity n _ 10 5 0 No of Stones Plumbing Inspector The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an e n,llclyer of !allot undcr the Florida Workrnen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent : upi lement, and ilas .rn �• with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed I y him in ' e rk c' is- performed under this permit; and will post or cause to be posted for inspection on the site of the work such pub]: notice r no icer 45 a• required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed 1 this J,rl ilk, a: mr . licensed by Miami Shores Village. ( signed) % =�' - -- Mast x Plumber Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take ack nowledgmente, periorr: ' ppear•u 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 tint all acts therein by him stated are true. My Coaunission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection a mede•neoeswry by Improper notice for inspe'tcs%, (Ir faulty materials and /or workmanship. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date � e i Time Type Insp'n Permit No. Name v Address fr‘i y 6 5-t Company 5.u. 6 Phone # , � � � � 0 S'i) For Inspector: Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 B ilding Inspection Request F T ime Dat 0 p Type Insp'n t )ove? kJ4 5 " Permit No.4k.5 00 Name U 1 l Address (7 Company Phone # For Inspectors 4/ 3' Approved Correction Re- Insp'n Fee o Time Type Insp'n_��� t ) L L' Permit No. � r Name �f" y y�r: ��, . Address MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Dat It/ 07,0 e96 Company . ./.'r. �/L.A Phone # / 8 i `3 For Inspector: g Approved Correction ❑ Re- Insp'n Fee ❑ L ' 93 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date O /C / Typelnsp'n ✓ rte I C - etc ) Permit No. 4 -05 - 8C- N ame Ar( 1 l3orm ZeJ k _D i Address 4Z0 u E q5 ,7 Company Phone # (305 ) 4ss -343 - D Inspection Date (7-3- / 1 /'o Approved Correction Re- Insp'n Fee MIAMI SHORES VILLAGE , BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date Type Insp'n Permit No. Name Address Company Phone # Inspection Date Approved Correction Re- Insp'n Fee • BUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) 7-rr6 'vx 2eA u7-t; ' +Z Phone # . i Owner's Address 4'' 1- City ,A11 WyH I S tk?1 State V'L Tenant/Lessee Name Job Address (where the work is being done) 0-Q (• 16 /1d1 City Miami Shores Village County Miami -Dade Is Building Historically Designated YES NO Contractor's Company Name W Mft2in / teS W11/ f/jQ Phone # .-!i5 Contractor's Address City _`I Qualifier �1 /S State Certificate or Registration No. ` ` Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # S Value of Work For this Permit /* c-t/ Square Footpge Af Work: M Type of Work: ['Addition CI Alteration New Describe Work: L4J c i (C&1, Submittal Fee $ Notary $ Scanning $ Code Enforcement $ Total Fee Now Due $ 1-t State * ** * * * * * * * * * * * * * * * * * * * ** *F es ,t * * * * * * * * * * * * * * * * * * * * *** * * * * ** r f i Permit Fee $ / 7J 4 , l CCF $ (1 " CO /CC a (0 v Technology Fee $ 4 5 Radon $ Zoning Bond $ ) 0 - an_ Structural Plan Review. $ Training/Education Fee $ (Continued on opposite side) � C C) ( _ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Master Permit No. Zip 2 i - 7 % 2 7(j Phone # Permit No. P10 $ 50 Mechanical Roofing Zip Zip 31( EJ Repair/Replace ❑ Demolition AMMOlimie 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 Signature Owner or Agent Contractor The foregoing in trument vas acknowledged before me this The foregoing instrument was acknowledged before me thus 9 day of , 20 W, by , day of MaTh , 20 who is personally known to me or who ha s product d`D.L • li 1 tl t lb a . en n and who did take an oath. NO NOTARY Print. �� +.' _ . •..�,,/�,;:u. 1 n,� P * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 05/13/03 }yhn is n Uvie.=..4 t me or who has produced as identi do who did take an oath. My Commission xpires: %/ ytofffnTrssToirt pars. y ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** *********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 4'� J Plans Examiner Engineer Zoning Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: PL2005 -86 Printed: 3/18/2005 Applicant: ALLISON ZELKOWITZ Owner: ZELKOWITZ ALLISON JOB ADDRESS: 420 NE 95 ST Contractor THE NEW MIAMI SHORES PLUMBING Contractor's Address: 900 NW 144 ST Local Phone: 786 - 553 -5424 Parcel # 1132060140461 Plumbing Permit Page 1 of 1 Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 9 & 10 BLK 52 LOT SIZE 100.000 X Fees: Description Amount FEE2005 -3501 Building Fee $175.00 FEE2005 -3502 CCF $1.80 FEE2005 -3503 Training and Education Fee $0.60 FEE2005 -3504 Technology Fee $4.38 FEE2005 -3505 Scanning Fee $3.00 FEE2005 -3506 Builders Bond $300.00 Total Fees: $484.78 Total Fees: $484.78 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 9/6/2005 Construction Value: $2,400.00 Work: INSTALL NEW DRIANFIELD Signed: (INSPECTOR) R _18 PAID 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: J To: A , You are hereby directed to abate an insanitary condition existing on property under your control at ,.,(City Address, land description, etc.) in the county — - -- , State of Florida, contrary to the Laws of the State of Florida and which subject the offender to a penalty for failure to remove or abate the below- described nuisance. - G disclosed (date) (des nbe the violation) An inspection on 2 / ,dc�rf ✓ ✓ � which violated Chapter No. c/ 6 °h Section No. (1 H - J of the Served By Name: Title: o Telephone number: 1Y ...57 i - 3 t/ �G Served upon at /if ( A/. /= 2 (Street) on the - J day of 3 by delivering a true copy hereof. Note: Serving may be accomplished by personal delivery, certified mail to the last known address or by attachment to the occupied office or residence. Witness the execution and delivery of this notice I Signature of Health Official County Health Department OFFICIAL NOTICE TO ABATE A SANITARY NUISANCE t. Authority: Chapter 386, FS DH Form 4044, Feb 99 (Obsoletes previous editions, which may not be used) Stock Number: 5744 - 000 - 4044 -1 STATE OF FLORIDA DEPARTMENT OF HEALTH (County Health Officer) (Town or City) , AD, ' Pt. `, at / 5 ) o'clock R_05- diC; P M., Ronald Cave On -Site Sr. Sanitation & Safety Specialist Department of Health age Disposal &Treatment System NW Building E _Suite 130 Miami, Florida 33166 Phone: (305) 51 Email: Ronald Fax: (305) 51372 Cave ®doh.state.kus - - vC_ Z ee k_. STATE OF FLORIDA DEPARTMENT OF HEALTH ONSIZE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR [. ]New- System [ X )Existing System C( • ] Repgit ( l Abandonment APPLICANT: Zelkowita, Steven PROPERTY STREET ADDRESS: 420 Ni 95 St Miami FL 33138 LOT: 9 BLOCK: 52 PROPERTY ID #: 11- 3206 - 014 -0461 SYSTEM MUST 88 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. .,ir. SYSTEM DESIGN AND SPECIFICATIONS D A I N F I E L D ]Holding Tank ]Temporary AGENT: ROTO ROOT. Garcia Raul SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.1 (OR TAX ID NUMBER) ) Gallons SEPTIC TANK (Gallons 1GALLONS GREASE INTERCEPTOR CAPACITY ]GALLONS DOSING TANK CAPACITY ( 0 ] GALLONS ( 571 1SQUARE FEET PRIMARY DRAINFIELD SYSTEM ( 0 ]SQUARE FEET SYSTEM TYPE SYSTEM: [ N )STANDARD ( N JFILLED CONFIGURATION: ( N )TRENCH ( N 1BED SPECIFICATIONS BY: Garcia, Raul TITLE: APPROVED BY: Millen, Jorge TITLE: Engineer I 1/41 ?SLI CENTRAX q : 13 -8G -24241 DATE PAID: FEE PAID : $ RECEIPT : OSTDSNBR : 05 -0828- -8 ( ] Innovative Other ( NA ) MULTI- CHAMBERED /IN SERIES: (Y ] MULTI-CHAMBERED/IN SERIES: (Y ] IN [0 ]DOSES PER 24 HAS # PUMPS( 0 ] (N (MOUND ( N FILL REQUIRED: ( 0.0 ]INCHES EXCAVATION REQUIRED: [ 0.0 ) INCHES ( N LOCATION TO BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE [ 0.0 1 [ FRET 1 ( BELOW ]BENCHMARK/REFERENCE POINT BOTTOM OF DRAINFIELD TO 8E [ 0.0 1 [ FEET ] [ 1BENCHMARK /REFERENCE POINT OTHER REMARKS: [CP] Install 12° of slightly limited soil under the bottom of drainfield. Perimeter of excavation area shall be at least 2 ft. wider and longer than the proposed absortion bed or ttench. Invert elevation of drainfield to be no less than 6.50 NGVD. Bottom of drainfield elevation to be no leas than 6.000 wrvn. Dade CHn DATE ISSUED: 3/11/05 EXPIRATION DATE: 3H :4016, 03/97 (obsoletes previous editions which may not be used) f statk Numbcr: S744.001-4016 -0) faecal, sass 1414 -1i FA 7r1t1.-1 6 Y 1 I S Y I 71 bCC TCCGiF T T :71 CG017 / T T /C13 Paow 1 of STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM C'.ONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X )Repair [ ]Abandonment [ ]Temporary [ NA ] APPLICANT: Zelkowitz, Steven & Allison AGENT: WALLACE P, Ponder Wallace PROPERTY STREET ADDRESS: 420 NE 95 St Miami FL 33188 LOT: 9 BLOCK: 52 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 014 -0861 [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 [ 1050 ]Gallons SEPTIC TANK MULTI- CHAMBERED /IN SERIES: [Y ] A [ 0 ]Gallons MULTI- CHAMBERED /IN SERIES: [Y ] N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS Q [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ •400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 )SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ] N F LOCATION TO BENCHMARK: Top of Bottom Floor, 12.00' NGVD. I ELEVATION OF PROPOSED SYSTEM SITE [ 1.6 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 3.6 ] [ FEET ] [ BELOW ]BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 24.0 ] INCHES OTHER REMARKS: THIS PERMIT IS NOT FOR ADDITIONS. *Existing 1050 gl. septic tank to remain. *Install 400 sf of drainfield. *Invert elevation of drainfield to be no less than 8.90' NGVD. *Bottom of drainfield elevation to be no less than 8.40' NGVD. SPECIFICATIONS BY: Icaza, Carlos DATE ISSUED: 4/1/05 TITLE: DH 4016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) (oatde cone 4016 -i( CENTRAX #: 13 -SG -24494 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 05 -1081- -R EXPIRATION DATE: 6/30/05 APPROVED BY: Icaza, Carlos 4 TITLE: Engineer I Dade CHD Page 1 of 2 PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. Notes: Site Plan submitted by: Plan Approved z By f ; /i " /7 &', 1 j i / // ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10198 (Replaces HRS•H Fare 4015 which may be used) (Star* Number: 5744 -002- 4015 -6) STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number T Not Approved Signature Title Date County Health Department Page 2 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number Scale: Each block represents 5 feet and 1 inch = 50 feet. PART II - SITE PLAN DH 4015, 10/96 (Replaces HRSH Forth 4015 which may be used) (Stock Number: 5744-0O2-4015-6) ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Site Plan submitted by: %�' . - �� r �" % `= Signature Title ll Plan Approved Not Approved Date ; By County Health Department Page 2 of 3 l I e E cob w APPLICANT: LOT: PROPERTY ID 1: TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR`OTHER QUALIFIED PERSON.: ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL;.EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [A YES [ ] TOTAL ESTIMATED SEWAGE FLOW: , GALLONS AUTHORIZED SEWAGE FLOW: GALLONS UNOBSTRUCTED AREA AVAILABLE: SQFT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS ✓,.1; [INCHES /FT) [ ABOVE /$ELOW]BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN SE MAINTAINED FROM THE SURFACE WATER: „`�` FT DITCHES /SWALES: i /9 y` WELLS: PUBLIC: ✓ FT LIMITED USE __LL LL _ ,y2/ FT BUILDING FOUNDATIONS: FT PROPERTY LINES: SITE SUBJECT TO FREQUENT FLOODING: [ ] YES 10 YEAR FLOOD ELEVATION FOR SITE:, SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture ( r. %,; r USDA SOIL SERIES: Depth to to to to to to to to to _� OBSERVED WATER TABLE: Nfa INCHES [ABOVE / EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION % ' INCHES [ ABOVE /(eBELOW EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES ('1 NO MOTTLING: [ ] YES [ 3 NO DEPTH: li-i INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: F °; h DEPTH OF EXCAVATION: i INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [ 4" BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS a, ,f 1 . BLOCK: DH 4015, 10/96 (Replaces HRS -H Form 4015 [Pape 3) which may be used) (Stock Number: 5744- 003 - 4015 -1) SUBDIVISION: [A' NO FT MSL /NGVD AGENT: [Section /Township /Range /Parcel No. or Tax I Nuabdrj NO NET USAELE. ,AREA. AVAIIA E: i ; ' ,' ACRES PER DAY (RESIDENCES_ -TABLE 1,/QE-TABLE 2] PER DAY [ 1500 GPD /ACRE OR -25A.Q_,QPD,/3[CRE] UNOBSTRUCTED AREA REQUIREDs '4' SQFT PROPOSED SYSTEM TO THE FOLLOWING FEATURES:, �. FT NOJUMALLY WET? [ ] YES ,[ ]" NO PRIVATE: _ �,'' FT NON - POTABLE: 1, FT FT POTABLE WATER LINES: - FT 10 YEAR FLOODING? [ ) YES [ ) NO SITE ELEVATION: FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 Munsell #/Coloy USDA SOIL SERIES: PERMIT # Texture t 4 Depth to to to to to to to to to DATE: Page 3 of 3 R,,,14.1 /'per INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative,. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number). PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential), Chapter 10D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet minimum setbacks in Chapter 10D -6, FAC. The unobstructed area must be contiguous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be verified. FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. SOIL PROFILE INFORMATION: Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be determined. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth. SOIL TEXTURE: Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION: If applicable record depth excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ + ] SHOT H.I. N.I. H.I. H.1. [ - ) SHOT [ - ] SHOT [ - ] SHOT STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [f.] New System Existing System [ ] Repair [ nA Abandonment APPLICANT: AGENT: MAILING ADDRESS: % TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(a) OR 489.552, FLORIDA STATUTES. PROPERTY INFORMATION LOT: ‘;-'' BLOCK: PROPERTY ID #: /I SUBDIVISION: ZONING: PROPERY SIZE: "��;;, ACRES WATER SUPPLY: [ ] PRIVATE PUBLIC [ ] <= 2000GPD [ ])»2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / PROPERTY ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 [ ] Floor /Equipment Drains SIGNATURE: `:G. /' r,. [ !J RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial /Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E -6, FAC DH 4015, 10/97 Page '1 (Previous editions maybe used) Stock Number: 5744 - 001 - 4015 -1 PERMIT NO. DATE PAID: ,. FEE PAID: ' RECEIPT #: - Holding Tank [,'A' Innovative Temporary [ ] TELEPHONE: PLATTED: 11/4 I/M OR EQUIVALENT: [ Y / N ] DISTANCE TO SEWER: f . FT ] Other (Specify) DATE: Page 1 of 3 APPLICATION FOR: APPLICANT: AGENT: TELEPHONE: MAILING ADDRESS: LOT, BLOCK, SUBDIVISION: DATE OF SUBDIVISION: PROPERTY ID #: ZONING: PROPERTY SIZE: WATER SUPPLY: SEWER AVAILABILITY PROPERTY ADDRESS: DIRECTIONS: BUILDING INFORMATION: TYPE ESTABLISHMENT: NO. BEDROOMS: BUILDING AREA: BUSINESS ACTIVITY: FIXTURES: SIGNATURE / DATE: Check type of permit, if "Other" specify type in blank. Property owner's full name. Property owner's legally authorized representative. Telephone number for applicant or agent. P.O. box or street, city, state and zip code mailing address for applicant or agent. Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot legal description or deed must be attached. Official date of subdivision recorded in county plat books (month/day /year) or date lot originally recorded. Dividing an approved lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot. 27 character number for property. CHD may require property appraiser ID # or section/township /range /parcel number. Specify zoning and whether or not property is in 1/M zoning or equivalent usage. Net usable area of property in acres (square footage divided by 43,560 square feet) exclusive of all paved areas and prepared road beds within public rights -of way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. Contiguous unpaved and non - compacted road rights -of -way and easements with no subsurface obstructions may be included in calculating lot area. Check private or public <= 2000 gallons per day or public > 2000 gallons per day. Is sewer available as per 381.0065, Florida Statutes, and distance to sewer in feet. Street address for property. For lots without an assigned street address, indicate street or road and locale in county. Provide detailed instructions to lot or attach an area map showing lot location. Check residential or commercial. List type of establishment from Table 11, Chapter 10D-6, FAC. Examples: single family, single wide mobile home, restaurant, doctor's office. Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for occupants. Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully screened patios or decks. Based on outside measurements for each story of structure. For commercial/institutional applications only. List number of employees, shifts, and hours of operation, or other information required by Table II, Chapter 10D -6, FAC. Mark Floor/Equipment Drains or Others and specify item or "NA" if not applicable. Signature of applicant or agent. Date application submitted to the CHD with appropriate fees and attachments. ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded easements, onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage features, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any public well within 200 feet of lot. For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other features necessary to determine composition and quantity of wastewater.