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445 NE 94 St (3)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date ; 0 Job Address f Pt 9 5' .5 Folio / / 3 Z G ®/ 9 4 : 2 5 2 - ° Legal Description gifiNgf& Historically Designated: Yes No / Tenant /'°! i S / A-T o Kt Master Permit # –! � 0 , 1 Phone 30S `7 . c / Z S Contracting Co. /2 5'r/) 2 / 4c174: / 4' --1, 7i 4ddress 1 7 O / cam(/ / i /� �2- e t/�G4 Qualifier /� ��' Z/O SS# Phone To; 5 Y0 z 2 P state lief jv 0 1z. L Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECICAT.. ROOFING PAVING FENCE SIGN WORK DESCRIP'T'ION �"� 2 7G Xe, Owner's Address Square Ft. 3 � 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. 1 Signature of owner and/or Condo President P ate Notary as to Owner or Condo President Date My Commissi xpires: Estimated Cost (value) Signa e of Contractor O FEES: PERMIT 5© RADON C.C.F. l °" NOTARY r- Builder L Date Notary as to Contractor or Owner - Builder My Commission Expires: T 2-6° /�� L OO P 1 p �RGARITA Latina il Azoz i + S F ��YBEN v , a CC797277 lis a' O 4 MY COMMISSION EXPIRES OF FIP DEC. 17,2002 O Date BOND 30 TOTAL DUE 367 . APPROVED: Zoning Building Electrical Mechanical Plumbing Engineering APPLICATION FOR: [3.4 New System [ - K] Repair AGENT: MAILING ADDRESS: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: Unit Type of No Establishment 1 2 3 4 APPLICANT'S SIGNATURE STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC Existing System [ ,t Holding Tank [40 Abandonment [ /',f],' Other(Specify) APPLICANT: `� ! f -3 4j 5 04 -f f coL) / A) 0 ^> 7 of (,u)? e/ ( , TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] LOT: ), � e BLOCK: 43 SUBDIVISION: , I i ' I Jt �� DATE OF �� " 1 r�' ' SUBDIVISION: / '�) [Section /Township /Range /Parcel No.] ZONING: PROPERTY ID #: � _.. i C /4/ _. PROPERTY SIZE: ACRES [Sqft/43560] PROPERTY WATER SUPPLY: (7? `�/ �� 7 - BUILDING INFORMATION [\] RESIDENTIAL No. of Bedrooms ] Garbage Grinders /Disposals ] Ultra -low Volume FluahlToilets DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 1) which may be used) (Stock Number: 5744- 001 - 4015 -1) Building Area Sqft [ /1100 3 [ ] Spas /Hot Tubs ] COMMERCIAL PERMIT # DATE PAID FEE PAID RECEIPT # [`14 Temporary /Experimental TELEPHONE: CM /�/ , .\) ry 1 f 1 d r. /S r� -. $ ! f i ! ( '; [ ] PRIVATE /U ( itt) ,J'1ri # Persons Business Activity Served For Commercial Only [ \('] PUBLIC [ ] Floor /Equipment Drains [ ] Other (Specify) DATE: / Page 1 of 3 --:1 frt.. :t:: :o: riot in a racorder.. rtf:::::vit•ion, a ropy of lot • .• • : : - i1Iy 7,:.;0 10: fOr ' ; L:"!.1`":": roarial n lot. • ni if "Ctlne:' for rauplicant • ¶lly rathori:-.25: 2!" ir. city, ar. addi:..r for or 27 c't oir:tber for property 1:epawrit..it rnip• require prorterty appraiser 112:4 or suction/Lowir.inpiranot:/parcal number.) rt....r fen or:ail E.;:w.irl 1:12(:11 CO:113110U! ortrealonLa r:• olartiqictiona :".71 iild:et:Ie a...tree: or '.0r.e. and in. county. t.. :tirliaetiort.tt ti..• li•tir.:ion. fl•`7'.71.' : JU Iimen i0171 : AC. . - 12 1 .rn: Lirifla Lin,5la wid• horno, doco 2l2:2111C3:\ Count all itio:Tut dgneci. primar: Tor :Jr:tip:oft thore t expect:ie.. Lo :routinely provide 3leepin3 acco: for 5: of eneloacd • :::. of zarage, ci:rport, interior cr open o: atily lillased :..-tor.i.o.:etn.:n.Lit for o.::ch titoiy rt:Licture. rasiditv„ y361",3 ostabliahment. For ioitidentlal establishrnent, 2 pacers per 'corn irc • only. ?Loa::: of ae.ration, :a..quired Table : ikied i with oi• "NA" if not c.pplicible. SiptiLaure tti int or igent. aft:flit:talon on day submitted to I Iealtli Department with appropriate fees and attachments. A Fit,: rcr 5;10'.':/jW' boo locrtionr of . .. - ..:r.idences or buildinE,ai, w:inn pools, recorded dirpor.ril cur. rap,; of rny :in a: pl drainr..•sc obsti t"./i710:.% :,c-';;;;10n of tv..11o, oriaite curface wr.tera, and • :: OF 7:arty, if •Litt: itur.. vi !rc 75 :7c:A othc cpplicant il.ocation. of any pu.)1:c ‘. 2C0 fee: of loL. 1FOF jc. a, floor plr• (rcald.:ticurt) olihadrooraa cr.ia each unit. ".1 plan rhowir:; - 2112m1)ing drains Ly?an, and 0:11er fro:ton:in to detel•Iriin:7; cor on :sic: rinaniiiy wari:awatii:. APPLICANT: poll te. v l 10 ,c 0 (ICJ AGENT: 4 s ut° ePh e A/k LOT: , 2 o i BLOCK: 62 SUBDIVISION: A ' cl A.1 1 o f eS, S PROPERTY ID #: II `. 32 o6- /9l _ G C 0 2 o [Section /Township /Range /Parcel No. or Tax ID Number] STATE OF FLORIDA', DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS 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: [ ] TOTAL ESTIMATED SEWAGE FLOW: 400 AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: BENCHMARK /REFERENCE POINT LOCATION: 6 7/ 1� 1- ► S h , 4 (f F ('/ ) /e- ELEVATION OF PROPOSED SYSTEM SITE IS 1/ [LI /FT] [ABOVE/BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATU S .;�, SURFACE WATER: ; C FT DITCHES /SWALES: /.J�I FT NORMALLY WET? LI. [ ] NO WELLS: PUBLIC: (J FT LIMITED USE: FT PRIVATE: FT NON - POTABLE: FT BUILDING FOUNDATIONS: FT PROPERTY LINES: Sr FT POTABLE WATER LINES: �j(j FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES `X] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture 0 c ,iJ ti USDA SOIL SERIES: Depth Ito_ to to to to to to to to e / ( ,INCH S' [ABOVE ESTIMATED WET SEASON WATER TABLE ELEVATION: HIGH WATER TABLE VEGETATION: [ ] YES (--,4 NO OBSERVED WATER TABLE: YES [ ] NO NET USABLE AREA AVAILABLE: Try ACRES GALLONS PER DAY [RE'SIDENCES -TABLE 1 / OTHER -TABLE 2) GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] SQFT UNOBSTRUCTED AREA REQUIRED: b Q Cl SQFT e PERMIT # 6()/ ®-$ 10 YEAR FLOODING? [ ] YES 60 NO $ FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 Mu sell # /Color Texture USDA SOIL SERIES: �• g ' Depth° l )' to to to to to to to to to / EXISTING GRADE. TYPEL__[ / APPARENT] W ] EXISTING GRADE. DEPTH: r; INCHES f INCHES [ ABOVE .BE 4 t� SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: - t ✓� � ' 4'7 a & ,DEPTH OF EXCAVATION: _ % INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [\ ] BED [ � > . 9 . T'EIf (SPECIFY) REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY: I DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 31 which may be used) (Stock Number: 5744 -003 - 4015 -1) ' MOTTLING• • G YES [ ] NO DATE: f el3/ /7 Page 3 of 3 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: 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. UNOBSTRUCTED AREA: 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. MINIMUM SETBACKS: 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 of 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. H.1. H.1. H.1. [ - ] SHOT [ - ] SHOT [ - ]SHOT - ---- ,1 / ' - ....r/ ft.. r -.... .. 5 - f. i'"_ d - I �I / r� i %! i� Or q /( S J t 1----_ 11 � • F , N // 1:�• y -fir ' % L ,— - N r �. > / - . � ' , 1 F 11 r 1. i G STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT : Permit Application Number • Each block represents 10 feet and 1 inch = 40 feet. Notes: Site Plan submitted by: fr Plan Approved ®_, B Y t. r , DH 4015, 10/96 (Replaces HRS -H Fomi 4015 which may be used) (Stock Number: 5744 - 002. 4015 -6) PART II - SITEPLAN Not Approved ALL GH MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Date !. ,f (- f ' County Health Department Page 2 of 4 CONSTRUCTION PERMIT [, ] New System [ [ `a Repair APPLICANT: PROPERTY STREET ADDRESS: D R A I N F I E L D 0 T H E R 401047] J S TYPE SYSTEM: CONFIGURATION: FILL REQUIRED: [ SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH O SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC 44:cs- tV E [ —J STANDARD [ ].TRENCH ] INCHES !2 DH 4016, 10/96 (Replaces HRS -H Form 4016 [page 1) which may be used) (Stock Number: 5744 - 001 - 4016 -0) AGENT: s ger ,3-it ARE FEET^P AR* DRAI1rT$LD SYSTEW ) [ ] FILLED PERMIT 0 ) D DATE PAID FEE PAID $ RECEIPT 0 LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE [ BOTTOM OF DRAINFIELD TO BE ( 4517 ) EXCAVATION REQUIRED: ("3 ] INCHES ,applicant TITLE: TITLE: LOT: 73,, � 7,1i BLOCK: - - SUBDIVIS.,ON: , J frf mil. • , a;t3 eC F9R: AL Existing System [/ ] Holding Tank [ /,L Temporary /Experimental Abandonment (her(Specify) PROPERTY ID 0: e 4, [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] 1 1 ' € ' ) C - � � ° C- (OR TAX ID NUMBER] 0 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. DEPARTMENT OF HEALTH 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 W ] Gkl.,1, s GPD]L.EPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:( ) A [ ] [GALI "/ GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:( ) N ( ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K ( ) GALIONS PER DOSE DOSING TANK CAPACITY DOSE .RATE ( ] PER 24 MRS NO. OF PUMPS: [ ] [ J MOUND [ [ J 7FT,] [ABOVE WJ- BENC. • ' RK /REFERENC POINT ET] [ABOV•^ SENCHMARKI FERENCE POINT c , CHD EXPIRATION DATE: (4 _Oct -al Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number by County Health Department. APPLICATION FOR: Check type of permit; if "Other" specify type in blank. APPLICANT: Property owner's full name. TELEPHONE: Telephone number for applicant or agent. AGENT: Property owner's legally authorized representative. MAILING ADDRESS: P.O. box or street mailing address for applicant or agent. LOT, BLOCK, SUBDIVISION or PROPERTY ID#!: 27 character ID number for property. (Health Department may require property appraiser ID# or section /township /range /parcel number.) SYSTEM DESIGN AND SPECIFICATIONS: TANK: DRAINFIELD: OTHER: SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: EXPIRATION DATE: Minimum specifications from Chapter 10D -6, FAC. Minimum specifications from Chapter 10D -6, FAC. Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. Name of individual providing specifications. If designed by a registered engineer must be sealed. County Health Department personnel reviewing and approving permit. Date permit is issued by County Health Department. One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. APPLICANT: 0./1 AJSe ti AGENT: S / f1 7 ace o Ad kr C-u PROPERTY_ ADDRESS: ' «S3 4/6: 9 '1 7 377". 1 7 ` LOT 24 BLOCK: 5L SUBDIVISIONt Al /h-71 # . ' S4 PROPERTY. ID CHECKED (X] ' ITEMS ARE NOT_ IN COIWLIANCI WITS STATUTE OR RULE AND- IWST ' BE CORRECTED.: TANK INSTALLATION ] [01] TANK. SIZE - [1] l [02T ' TANK MATERIAL G•NG2er ] [03] OUTLET DEVICE 9 ]. [04] MULTI-CHAMBER= [ Y ./ (0 ] [ 05 ] '' ; OUTLET FILTER . ' i3"1' ] ' [06] ' LEGEND 1 (07]. WATERTIGHT: ' � f 7 . / r J ] : [08] LEVEL _ . ©�.. [09] DEPTH •TO LID,4/' DRAINFIELD NST r 1TI [ 10]. AREA .[1] tb/fo] '7 ZSQFT ] [11]. DISkIBUTION BO2 f ] (12] NUMBER OF. - DRAINLINES .. . • 4 - ] [13] DRAINLINE`SEPARATIONS p ] 1 [14]'. . DRAINLINE. SLOPE . � . .. ] [15]. : DEPTH " OF COVER '/ 7 ] [16] ELEVATION;_ABO ] ] [ 17 ] . SYSTEM LOCATION ] [18] DOSING PUMPS ]• [19] AGGREGATE SIZE S'7 ] [20] AGGREGATE EXCESSIVE FINES [ ] [21] AGGREGATE DEPTH '$ .7 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DIPOSAL SYSTEM CONSTRUCTION INSPECTION AND FINAL APPROVAL /CoeV FILL. EXCAVATION NATERIAL ] . [22] :; FILL' AMOUNT '. Qf'( ] [23] FILL TEXTURE B'C ] (24] • EXCAVATION DEPTH 3 ' .� ] [ 2 5 ] AMA REPLACED .. Q v'r ] [ 2 6 ] REPLACEMENT MATERIAL EXPLANATION OF VIOLATIONS REMARKS: CONSTRUCTI DE 4016, 10/97 (Previous Editions Nay Be Used) 1 1 1 l 1 l 1 1 PERMIT NO. DATE PAID: FEE PAID: RECEIPT SETBACKS [27] SURFACE WATER [28]. DITCHES [29] PRIVATE WELLS, [30] , PUBLIC WELLS= Installer / Contractor FILLED / MOUND SYSTEM FT: [31] IRRIGATION WELLS �� FT [32] - POTABLE WATER. LIM y [33]'. BUILDING FOUNDATION � • • FT. [ 34 ] . PROPERTY: LIItES . 'S P'1' = . [35) OTHER • .FT ... - [36). COVER 1 � 3 7] SHOULDERS {3$]' SLOPES . STABILIZATIOW' :'• DITIOii L INFORMATION' t'40 • UNOBSTRUCTED4lmmA 6 c• [41]. STORMWATER RUNOFF (42] ATARNS ` [431.. MAINTENANCE ix, ^O (/ 7.4'0 U Soori //13nd 06.0 /�6i . 2 G [44] BUILDING ARE7► 441 U (A L OCATIOi1 S ,WITH SITE ' PI$IT 1 y — s [ 46 ]- ` FINAL SITE AD> {'_ . _ „ • . l : L ) [47] ]. [48] OTHER ABJUIDONMENT [49r [so] • TANK canasta & FILI3D -/ • APPROVED ISAPPROVED] : / / , A A - 6 , J % CND DATE: /- /O - 0 G FINAL SYSTO:iiiIIROVEDigISAPPROVED]:. ' A1474 -.." CND! DATE:, /-1a.'-ioi?.:', . Page 2 of 3