443 NE 95 St (7).
Date 12-120 I Job Address j tJl: G!S s-4-Ye e f Tax Folio W 0 - 01
Legal Description
Owner/Lessee / Tenant Ml t I \ l O f t 1 31 Master Permit #
owner's Address 143 t 95 S>112- Phone '7 Se — C SS C1
Mire
contractin co. L LOID- NOQ-T ,T) DE a. RTC Address & NW it 1 ? 2 EET ? j I C r
Qualifier b� N tJ tS tie. h L L f= SS# / Phone
State # 0'253'6 -S' Municipal # Competency # 1 2g4.2., Ins. Co. '1 F/' -10-0
Address
Architect/Engineer
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL LUMB MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION KSTIN a00 5p F l f R4-t N Pt t -D.
Square Ft. 30o
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 tc 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 an :t all work will be done in compliance with all applicable
con actor to d• . ork stated.
laws regulating construction and zoning. Furthermore, I authorize the above -n
Signature of owner and/or Condo Presi
na
o Owner and/
My - • ssion Expir
FEES: PERMIT
11 q(2 2658
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
1 %%VW . 'SS's
� V o4e Teresa J. Felder
s 1 ' Notary Publiz, Si::::. of F}sritla •
i)1 ,i Commis�?an No. CC 4CO3 :•7 '
> -- eo KO" . _ My Commission rrpirea 07 /16/39 •
> 1.400.3 TARP- Pla Nary SW*:& BorEargCo. •i
!!e !!!!!!!e!!!!!etet!t!!!!!fe (t!!etaa!!!!!? � 1
57 ' O RADON
ident Date
APPROVED:
Zoning Building
Mechanical
Historically Designated: Yes No
Plumb
C.C.F.
Estimated Cost (value) * '( O t3.00
L
a�. eofC,ntractor rt
koR
Notary to Contra
mmission
Teresa J. Felder
Notary Publ'_a y::c of F'-r "a ' i
Commis^:on Nti. Cc 4 7
eoF Ws' My Co a Lz�ir.-: 67 /1Ci;9
1- sao•34a TAL �q
Y- FtaJin^, rhas('rrX,F4 la
eiretareateteeeeatenTeerecaaaaaaatetah
O NOTARY BOND
TOTAL DUE ,.5.7 fo
Electrical
/// Date
lZkot Cie
er- Builder Date
er- Builder
owes
Engineering
1
0
T
H
E
R
LF_1:J' 1 1d rU
,12/20/1996 .5 :50 3057511870
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: / 249_,T:76
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
CO PERMIT F
[/ ] New System (.111 istinq System (A6 /ding Tank (Al'
(y) Repair C Abandonment ( other(Speeify)
APPLICANT: AGENT: 216
/ /s-? / - s'•- 4- ec -A F" 5 !' '7" / ST
-- �6lt'-rR' :
L4
PROPERTY STREET ADDRESS: �.[� .4./E, 9 - " �`�" /
LOT: N 4 BLOCK: I14 SUBDIVISION:
4,4L.
PROPERTY ID #: // es/42/ G �� ( SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
-•- (OR TAX ID NUMBER)
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS WHICH SERVED AS A
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH
MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID.
SYSTEM DESIoL S CtFICATIONS
T [ /4 I, - 1111 // CPD) TIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:( J
A ( ) (GALLONS / CPD/ " ../ CAPACITY MULTI- CHAMBERED /IN SERIES:( J
N ( ) CALLONS 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 (3GC..)1 QUARE FEET PRIMARY DRAINFIELD SYSTEM
R ( 1 SQ FE TT SYSTEM
A TYPE SYSTEM: [ ] STANDARD ( ] FILLED ( ) MOUND
I CONFIGURATION: ( 1 TRENCH (G}r$ED ( )
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE (45%
E BOTTOM OF DRAINF:fELD TO BE ( Z cZ
L
D FILL REQUIRED: ( ) INCHES
7
)
LLOYD -N DADE SEPTIC
TITLE:
PERMIT #
DATE PAID
FEE PAID $ 6 'CA
RECEIPT # /C 2 '2
(
EXCAVATION REQUIRED: (_ C] INCHES
,. . :NW: •• - .r
$RS -H Form 4016, Mar 92 (Obscletes previous editions which may not be used) - (Stock Number: 5744. 001 - 4016.0)
.net i# &MT__
9
)
PAGE 01
INCNE , FT] (ABOVE /BELOW) BENCHMARK /REFERENC 'iFCS•L(T
INCHESI7T] (ABOVF3�BEL0W ENCHMARK E FERE NCE POI
TITLE; CPHt
EXPIRATION DATE: 2 - 20
.Page 1 o . :
12/20/1996 7.5:50 3057511270
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIOr&P IT
Permit Application Number (((
,••-•- -PART II - SITE PLAN••---- - -•• »•
Scale: Each block represents 5 feet and 1 inch 50 feet.
1
,
•
Notes:. MI `-
CL 3'
Site Plan submitted by: _
Plan Approved _ L
Not Approved _
LLOYD -N DADE SEPTIC
t, l
.. •
t
By
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
PAGE 02
. . • , t
1 ....t.i. :.,t
i
k.ES AFT T Cr RcH - 44-3 NE 95 51 7�33i
O E.M. 0011\16..
PwM PE D:I
flNAiu�iE ce / ..' i� a_ ! ZJ / cn
�
Date � ' • _ "(,
County Public Unit
L :
-
MIAMI SHORES VILLAGE, FLA.
JOB _14 u � . ( 1 . . . ) -
ADDRESS 4 4 Z 0. r Sa n
INSPECTION
N9 5030
L _,� �
TIME READY
REMARKS
INSPECTOR DATE in - 3 •11'