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DRAINFIELDPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY (OWNER TO RETAIN COPY) / �I Job Address �' A4 ,K=t � Tax Folio /� o2�(p ( ®�T�� Legal DescriptionfQ " k �02 g +/ Master Permit # 3 ✓ Owner / Lessee / Tenant z 4,..J i) , Owner's Address% X ,,r � , � phone 7 J 9 � F //; "- ' Contracting Co. / [ / /Gi /.7m "dy/7,4 -j", Address /W-5X7 d7 Qualifier //4 (' /- � �tl/�.C� SS# - - ; - phone���" f3;2 State# Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN WORK DESCRIPTION 9V7,/ / 7 /ill Square Ft. 4 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. 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. Furthermo I authorize the ove -named contractor to do the work stated. Signature of Owner and /or Condo President Date: A 41,ze91- N ry s to Owner and�(� M l� , � � I E� � � .tar�as to Contractor AR 9 POBfIC a Commission Expires. Y gONDED RU STEMBLER • DAMS &SW T y C omm i ss i on Expires * * * * ► * V1Y COMMI ION EXPI S APRIL 4, 1992 BONDEDRU STEMBLADAMS & SWEET PERMIT FEE: APPROVED: Fire Zoning A Building • Mechanical Plumbing Estimated Cost ► ti Other i--.> Signature of Contractor or Owner - Builder Date: r q Electrical // Eng ineering STATE OF FLORIDA EPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT - Date of Application ' •"'/ 7 ' � /01- Name of Owne Lei Telephone Number /J --,`,/-) Mailing Address of Owner 2 %'A46' 'g r 0 Owner's Agent 4 P0 Builder Agent's Mailing � �l Address � i fi %' a Telephone No. .1 " 957 Property Street Address Lot No. Block No: ; This Application is for. New :System,. Repair 1 Type of Residential NOTE: IF NOT INA SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION Type of Establishment 'S.t. Subdivision'"" HRS-H Forth 4015, Feb 85 (Obsoletes prerious editions which may not be used) (Stock Number. 5744- 001 - 4015 -1) Authority. Chapter 381, FS Chapter 10D -6, FAC Permit Application Number ART 1- APPLICATION , e Sewage Flow (Gallons per day) TOTAL FLOW = 9 —Q 5 Date Subdivided • Existing System Sewage Flow Based On No. Bedrooms Heated or Cooled Area No. Dwelling Sewage Flow (each dwelling unit) (each dwelling unit) Units (Gallons per day) Exact Directions to Property AUDIT CONTROL NO. Applicant's Signature w £ ' /8-9477 Page 1 of 3 PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date /b oZ ° Job Address 73 c /" - `l S Taa Folio) 1 3 0 O`1 L-( l l )3 el Legal Descriptio L• 17 ) fi 1 Historically Designated: Yes No 4 57 `✓ / Master Permit # $ Owner/Lessee / Tenant Owner's Address 7L/r / O , 1l 4‘ -- Phone 305 -7S Lo O/ ` Contracting Co. g C S Address Qualifier r/ ate!U b ss# Phone ;0> State # Municipal # Competency # Ins. Co. Address Address Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDIN ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION p /} e.,,Q- 00. (4. Square Ft. 8 00 Estimated Cost (value) l7 © o 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 ('`applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that ser° 's are required for ELECTRICAL PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. �^ OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and th f Z/ '1 all applicable laws regulating construction and zoning. Furthermore, I authorize the above -named contr"P'- /1 Y/ / 7/4 7 Signature of owner Condo President Date Notary as to Owner and/or Condo President Date My Commission Ems•+► 4E:4% % STEPHEN E. COCKING :.: MY COMMISSION It DD 031747 EXPIRES: June 20, 2005 0 .:10" Bonded Thru Notary Public Underwriters APPROVED: Zoning Mechanical FEES: PERMIT • tD , OD RADON C.C.F. Building Electrical OTAL DUE - 2 4 Plumbing J 1 Structural Engineer LOT: N/A OTHER REMARKS: STATE ,OF /FLORIDA DEPAJ vIAENT OF HEALTH UNSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT , CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X ]Repair [ ]Abandonment SYSTEM DESIGN AND SPECIFICATIONS L D FILL REQUIRED: [ 0.0 ]INCHES 11tiL ' T [ 2500 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]Holding Tank ]Temporary APPLICANT: Barry, Betsy AGENT: SR0931119, COCKING MSTEPHEN PROPERTY STREET ADDRESS: 716 NE 92 St Miami FL 33130 BLOCK: N/A SUBDIVISION: Shores Est ] Innovative Other [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 044 -0510 [OR TAX ID NUMBER] SPECIFICATIONS BY: Paul Levelt Andre, P.E. TITLE: EXCAVATION REQUIRED: [ 21.0 ] INCHES Invert Elevation Of Drainfield to be no less than 7.35' NGVD Bottom Elevation of Drainfield to be no less than 6.85' NGVD DH 9016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5794- 001 - 9016 -0) (ostds_cons 4016 -1( CENTRAX #: 13 -SG -10696 DATE PAID: FEE PAID : $ RECEIPT OSTDSNBR : 01 -3279- -R APPROVED BY: Andre, Paul TITLE: EH Supervisor P,W=1,9. DATE ISSUED• 1023/01 7H BERM 7P o � n y ;,�.:, j . e (4 / ,®IEFLE(��ifla,,1 C , %,r� - a Ca��b�a�EXPIL T1q[V 1i 1/02 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. MULTI - CHAMBERED /IN SERIES: [Y ] MULTI - CHAMBERED /IN SERIES: [Y ] ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 800 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ ° ']STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH [ /, -]BED [ N ] N F LOCATION TO BENCHMARK: Finished Floor Of Existing Res. Elev. 11.1' NGVD I ELEVATION OF PROPOSED SYSTEM SITE [ 2.5 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 51.0 ] [ L.vc- /ri [ BELOW]BENCHMARK /REFERENCE POINT CHD Page 1 of 2 I LI 1 LI ' C 0 12, u :mu I - - - - i Hr ■ , 11 1 , ., ' 1 ii 1_, 1111 _ 111 ,H 111 ! HILL 1 i H , H : u71 1 .____u_____',____L,___I 1 - 1 1 -- 1 ! 1 1 I I 1 1 I I I I 1 1 I 1 I 1 J__, i 1 , i I I 1 I I 1 I I 1 , I 1 1 I , t 1 • iii i ii 1 11 .1 r! i -1 . ..; i - f - 1 - 1 - , ___, . , 1 t i ii ,11 . : 1 By Notes DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITE PLAN __ Hi!it Hit immt::1 , 11H11 , 1! 11: 1 .....0 11 IJIIII__Ii 1111 1 _HI FI 171 ; 1 I__LID ta_l_l__LC _j__I__LI_L_LI_LLID_ - 1 - 1III - IIIIU '1111111_2_11: 1 • 1 1 i ;-. tillti 1 1 II '11 • 4,7 t ! 1 11 ! ! Fri c 00 c iP 10 tr. fi Plan Approved 1 HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number: 5744-002-4015-6) i I. ; i , i i 1 1 1 -- • 1 0_1 -. . - 1 --- 1 - 1 --- - - I - 1 . 1! 1 1 H r - 12 I - . I I - 1 1 I 1 I : ! ! 1 ' ' • 1 ; - - .., ..n ,, 1 1 I i I I ,. 1 I t , . 1 1 1 1 1 . 1 1 1 1 t 1 1 11 I 1 1 L-1 ttl1I .1 II . - I - 1 7 T 1 I STATE OF FLORIDA • ! I 1 t 1 ! ' • I Hi 111 1I 11 . 1' 1 11 1 1 I I , _ l I 1111 tIll I II' 'I I I l 1 I ' 1 I _ _1_1 __ _11 I_ _I_ _ _ _ __I __1_1_2_ _ 1 ' - -1- 1 -"-' I ' I 1 ! ! 111 1 I 4 , II 1 ' I ' 1 1' I 1 1 l II II / 1 1 1 1 1 1 ' 1 1 1 1 1 II , 1! ' , I , 1 I L 111 1 1 1 1 I I 'I I I i 1 1 1 i _L L_i_ __ _t_l_t_ _I_I_1_ _ _1_,) LI 1 I I I I 1 ! _l_ L, , ' I __1I_I_1__ ----,- 1 I_1 I , rr ' I I I l' ' " !T 1,,,i - i, 1 1 1 1 - t -,-,- .. --- 1 - 1" ------ 1 - 1 - lit - I ---- , --- 1 - , I I, , 1_,__ 11 I1 I i 1 I 1 1 _1___, _ _ .11 t 1 - 1I 11 t_ I I I I I - ' ! ', 1,4 1 ' ' _,__1_1 1 I 1 t_t_ _1_111 1_, __/4,1 IL,' _1 I I 1+11 - 1 2-1 i i I t I ; i t I j I 1 ' I I i i i 1 t21 - .7 -- t t , H if I- i * /6 1,.<114,_. i tAix4 ero' 4Pf e i i 1 I I ! 1 1 1 .-..,.-.?' I -,, r 1 1 . I Not Approved i I , I I -1 4 4,- • - _ Site Plan Submitted by SIGNATURE y /a-eft ( 61/3 ° \ — ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT 1 rd • / / TITLE • , I efi Date • - County Public Unit Page 2 of 3