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434 NE 95 St (6)By Plan Approved STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTAL , PPR IT Permit Application Number g/ U t ' PART I1 - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. I _ _ r ' l _ i 1 L. _ V 1._ _I ± I [_TT1 I J -, I l J J _L I+ ZI_ 11 f __ i I _' -: - -1 c1__ L I tl., Site Plan submitted-by: . �� ,,. � ,f^v4 �1^r�..,i� -v Not Approved it/? /.i' , 'aiN6 TITLE Date 3_a County Public Unit ALL CHANGES MUST BE APPROyED BY THE COUNTY PUBLIC HEALTH UNIT HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not bi used) • Page 2 of 3 (Stock Number. 5744 - 002 - 4015-6) CONS RUCTION PERMIT F9R: [Al New System [ [ \2] Repair [ I Abandonment PROPERTY ID #: 0 T H E R STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC D FILL REQUIRED: [ SPECIFICATIONS BY: APPROVED BY: DATE 1 SSUED: ,3 X24' isting System APPLICANT: e ve / , f� e..5,0 NT: 4 / 4 /.34' PROPERTY STREET ADDRESS: ,D `k s S4 _ ` _ LOT: 6 BLOCK: 67-72___SUBDIVISION: "'"W S' 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. SYSTEM DESIGN AND ,SPECIFICATIONS T if 6 ] GALLON GPD A [ ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D [3,0 SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET A TYPE SYSTEM: I CONFIGURATION: -05-TANK/AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] SYSTEM [ ] STANDARD [ ] FILLED [ ] MOUND [ ] [ ] TRENCH [ [ F LOCATION OF BENCHMARK: /ZS ` ' /� R 1 Po r - 1 J � � �` Dei I ELEVATION OF PROPOSED SYSTEM SITE [ / /.6) -^ ] [ABOVE /BELOW] BENCHMARK/REFERENCE-POW E BOTTOM OF DRAINFIELD TO BE [ ] [; NCHES FT] [ABOVVEELUR BENCHMARKFERENCE POINT L INCHES EXCAVATION REQUIRED: [0] INCHES &O HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001-4016 -0) lding Tank [ Temporary /Experimental Other(Specify) [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] TITLE: APPLICANT PERMIT # DATE PAID° 2 FEE PAID $ S V • , e) RECEIPT # TITLE: �'" CPHU EXPIRATION DATE: e2 .6° .,e, Page 1 of 2 • PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 3' ??-nr Job Address 4 3 4 4 5 Tax Folio Legal Description 750' d Avi Owner/Lessee / Tenant i t: ,Q Master Permit # Owner's Address 4 3 4 xyf Contracting Co. j / g-gje A4 Quali . A,,,�� � State # 07/6 Cg Municipal # /-7 d- Competency # 35 Co. 4t// ,, Architect/Engineer l Bonding Company Address Historically Designated: Yes No Phone 7 57- r 3 Address 9 4.io 5 Phone ‘1 Mortgagor Permit Type (circle one): BUILDING ELECTRICAL LUMBINGMECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION %' / //& fl / 7e7 / 4C.-6 —55 72, l Square Ft. Ala 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 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. /iii/ Signature of owner and/or Condo President Date Notary as to Owner and/or Condo President Date My Commission Expires: BOND 3 � "� z� S, c.) FEES: PERMIT J RADON C.C.F. r. NOTARY TOTAL DUE 3 y f APPROVED: Zoning Building Mechanical Estimated Cost (value) /POO c. mil ignature of Contractor.& Owner- Builder Date 411c../tA Notary as to Contractor or Owner -B My Commission Expires: F - . -11 � Pie Cyr: >0% .1 BAR 04141Fa . f CO:'.7MIs$IO;: iy g.:.i " , Q P ® CC360".L. Op II ��F tvw COMMISSION '7. ld- Date Date PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 3/0?3/9 0ob Address 1 .3V I E f.5 S+ - Tax Folio Legal Description Historically Designated: Yes No Owner/Lessee / Tenant & ver y ., G'C/YYi2S Owner's Address 1 7 1 .W /U C 73 -CY Phone 75 70 Y 3 Contracting Co. A - 1 /4-6 /e Ro a k-V Address / Qualifier SS# Phone y ' ' 7 7 ? 1 / Q State # Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Square Ft. Estimated Cost (value) 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 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. i" ' ature o / • or Condo President Date • Master Permit # Signature of Contractor or Owner- Builder Date Notary as to Owner and/or Condo President Date Notary as to Contractor or Owner - Builder Date My Commission Expires: My Commission Expires: t1 PU O L(FiZi ,EAL '/. O A P B '- SANDRA M MONTIEL ? 0 COMMISSION NUMBER `.. Q CC401261 4 �. 2 "'` „0 MY MY COMMISSION .EXP. Op FL AUCI, 1l22 !! FEES: PERMIT RADON C.C.F. NOTARY BOND TOTAL DUE APPROVED: Zoning Building Electrical Mechanical Plumbing Engineering BUILDING ELECTRICAL PLUMBING i00154 honer of ; uilding zrchitect ontractor Jr Builder . egal Description Lot MIAMI SHORES VILLAGE, FLORIDA ❑ DATE 7"" " V 19 PERMIT CONTRACTOR OR BUILDER N° 5475 Work to be performed under this Permit ^` +`✓ • — Contractor's License No , f 4'73 Subdi- Bl vision Address of r Value of Amount of Building "9s-' ,, . i Project $ I Permit $ _3. 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 applica- ion 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 'ermit 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. .•. .-1 Signed- - #-- ,^ esfc. INSPECTOR In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliante with aeot'6inarices 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. =epting this permit I assume responsibility for ell work done by either, myself, my agent, servant or employee. BY AUTHORITY nano• ''