490 NE 94 St (8)Permit No ?f
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date..
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
�1
Owner's Name and Address -___ - 77° _ - - - - -- — _- •---- - - - - - No.__ _
Registered Architect and /or Engineer__ — — _ _-- -- -- --------- ---- _ --_ -- _
G ir /cc� /VI L .` . ..
Employing Plumber's Name/`)- .E1.k" -- ' _ == -- -- -____- No. -_ �_� —� Street -- - - -__- _ . _...... __ - -.-
New Building_
Nature of Water Supply: City —Well
Amount of Permit $ __.
Size Septic Tank
Feet of Drain Tile. 4) ''- - - -- -Dist. Feet of Tank or Drain Field from Well
Location and Legal Description Lot____— ____— _______ — Block
Street and Number where work is to be performed —No 1-- C
State work to be performed and purpose of building (By Floors)_____ �1 ____ � t i eL ' a/
Street
Street 6 ✓/ '
___ Remodeling—__-... ______ ___ Addition_______ __________ Repairs v No. of Stories
_Type of Tank__ Capacity Gals.
Size of Soakage Pit
(Signed)-
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he `•2 rstands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen - Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, . n work7 be performed under this permit, as are
licensed by Miami Shores Village. ` ,i
- / = .„
(Signed)___ Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made •n- ssary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA
TORIES
S INKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
CONTR.
LIST
CHECK
Permit No ?f
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Date..
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
�1
Owner's Name and Address -___ - 77° _ - - - - -- — _- •---- - - - - - No.__ _
Registered Architect and /or Engineer__ — — _ _-- -- -- --------- ---- _ --_ -- _
G ir /cc� /VI L .` . ..
Employing Plumber's Name/`)- .E1.k" -- ' _ == -- -- -____- No. -_ �_� —� Street -- - - -__- _ . _...... __ - -.-
New Building_
Nature of Water Supply: City —Well
Amount of Permit $ __.
Size Septic Tank
Feet of Drain Tile. 4) ''- - - -- -Dist. Feet of Tank or Drain Field from Well
Location and Legal Description Lot____— ____— _______ — Block
Street and Number where work is to be performed —No 1-- C
State work to be performed and purpose of building (By Floors)_____ �1 ____ � t i eL ' a/
Street
Street 6 ✓/ '
___ Remodeling—__-... ______ ___ Addition_______ __________ Repairs v No. of Stories
_Type of Tank__ Capacity Gals.
Size of Soakage Pit
(Signed)-
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he `•2 rstands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled Gen - Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub - contractors, . n work7 be performed under this permit, as are
licensed by Miami Shores Village. ` ,i
- / = .„
(Signed)___ Master Plumber.
STATE OF FLORIDA, }
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 that all facts
therein by him stated are true.
My Commission Expires Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made •n- ssary by improper notice for inspection, or faulty
materials and /or workmanship.
Owner's Name and Address
Registered Architect and /or Engineer- s
State work to be performed and purpose of building (By Floors)
ss
appeared
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No.___ ? Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be c plied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work l
Employing Plumber's Name - 1 i / No
Location and Legal Description Lot
Street and Number where work is to be performed —No
Block
a
fl No Street •J �'"
Street _ "# +—' —
street_ -- e__ - --
New Building Remodeling Addition Repairs
Amount of Permit $- - (Signed)
Capacity Gals
(Signed)
The undersigned applicant for this building permit does hereby certify that he understands and accepts his 61Rigations as an
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement
plied with the provisions thereof. and will require similar compliance from all contractors or sub - contractors emplo ed by him in
performed under this permit: and will post or cause to be posted for inspection on •' site of the ork such ublic notice
required by the Act. The under signed agrees to employ only such sub - contracto n w. t i perfor d under t
licensed by Miami Shores Village.
Notary Public. State of Florida
No. of Stories
Size Septic Tank Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
, $i ze of pakage Pit.
Nature of Water Supply: City —Well.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments,
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 that
therein by him stated are true.
Inspector.
ployer of labor
, and has com-
the work to be
r notices as are
ermit, a re
Master Plumber.
personally
all facts
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT' NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
H EATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
Owner's Name and Address
Registered Architect and /or Engineer- s
State work to be performed and purpose of building (By Floors)
ss
appeared
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Permit No.___ ? Date
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be c plied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work l
Employing Plumber's Name - 1 i / No
Location and Legal Description Lot
Street and Number where work is to be performed —No
Block
a
fl No Street •J �'"
Street _ "# +—' —
street_ -- e__ - --
New Building Remodeling Addition Repairs
Amount of Permit $- - (Signed)
Capacity Gals
(Signed)
The undersigned applicant for this building permit does hereby certify that he understands and accepts his 61Rigations as an
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement
plied with the provisions thereof. and will require similar compliance from all contractors or sub - contractors emplo ed by him in
performed under this permit: and will post or cause to be posted for inspection on •' site of the ork such ublic notice
required by the Act. The under signed agrees to employ only such sub - contracto n w. t i perfor d under t
licensed by Miami Shores Village.
Notary Public. State of Florida
No. of Stories
Size Septic Tank Type of Tank
Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well
, $i ze of pakage Pit.
Nature of Water Supply: City —Well.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments,
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 that
therein by him stated are true.
Inspector.
ployer of labor
, and has com-
the work to be
r notices as are
ermit, a re
Master Plumber.
personally
all facts
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
APPLICATION FOR PLUMBING PERMIT �...
Permit No _
Date__ —
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be • .lied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of wor
Owner's Name and Address
Registered Architect and /or Engine
Employing Plumber's Name __ �'w'. Street
Location and Legal Description Lot " Block rr..t__ Subdivision.
Street and Number where work is to be performed —No. Street___ _1)4_'�___�
State work to be performed and purpose of building (By Floors) `�!_,___i�!_
New Building Remodeling Addition Repairs No. of Stories__________
Size Septic Tank Type of Tank Capacity Ga1s.______
Feet of Drain Tile__
Nature of Water Supply: City —Well.
Amount of Permit $
appeared
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
No.
Dist. Feet of Tank or Drain Field from Well
ze of akage Pit
- (Signed)
(Signed
No.
Street.-
The undersigned applicant for this building permit does hereby certify that he understands and accepts his igations as an e>Rfployer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors ernployed by him in the work to be
performed under this permit; and will .post or` 'cause to be posted for inspection on .' site of the ork such • blic notice or notices as are
required by the Act. The under signed agrees to employ only such sub - contracto w n w. k to " e p for . d utrder t • rmit, re
licensed by Miami Shores Village.
My Commission Expires Notary Public. State of Florida
� 1J
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
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 that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SI
KS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM'G
POOL
CONTR.
LIST
CHECK
APPLICATION FOR PLUMBING PERMIT �...
Permit No _
Date__ —
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be • .lied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of wor
Owner's Name and Address
Registered Architect and /or Engine
Employing Plumber's Name __ �'w'. Street
Location and Legal Description Lot " Block rr..t__ Subdivision.
Street and Number where work is to be performed —No. Street___ _1)4_'�___�
State work to be performed and purpose of building (By Floors) `�!_,___i�!_
New Building Remodeling Addition Repairs No. of Stories__________
Size Septic Tank Type of Tank Capacity Ga1s.______
Feet of Drain Tile__
Nature of Water Supply: City —Well.
Amount of Permit $
appeared
ss.
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
No.
Dist. Feet of Tank or Drain Field from Well
ze of akage Pit
- (Signed)
(Signed
No.
Street.-
The undersigned applicant for this building permit does hereby certify that he understands and accepts his igations as an e>Rfployer of labor
under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors ernployed by him in the work to be
performed under this permit; and will .post or` 'cause to be posted for inspection on .' site of the ork such • blic notice or notices as are
required by the Act. The under signed agrees to employ only such sub - contracto w n w. k to " e p for . d utrder t • rmit, re
licensed by Miami Shores Village.
My Commission Expires Notary Public. State of Florida
� 1J
Master Plumber.
STATE OF FLORIDA,
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
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 that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
---
Date
OWNER
dd�ia►ni ShoresCillage
F L 0 R i D A
PLUMBING PERMIT N9 730
Issued to
Total $
Village Plumbing Inspector
Received Payment by
LOT
BLOCK
:,. rk 3'11'y
SUBDIVISION
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a story building at
Fixtures
Fixtures $
Sewer $
Septic Tank $
'
Permit No. .___. Date - - -1 -- _ y - `S -S
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub ted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owner's Name and Address
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Engin er �__._. __ - .---- _--------- -.__ -_
s /o
Employing Plumber's Name ` __?"'� No. __/_} d 01 Street .I
Location and Legal Description Lot___ __ lock___ yy _.____._____ ______ Subdivision Street and Number where work is to be performed —No _. _U !1_ _ Street_ ft - -
State work to be performed and purpose of building (By Floors )___ - - -_- __ ..-
No 9.0 Street 95
adf
New Building Remodeling Addition._ Repairs No. of Stories
Size Septic Tank Type of Tank_ Capacity Gals
Feet of Drain Tile __Dist. Feet of Tank or Drain Field from We1L
Nature of Water Supply: City—Well ............... -........... _________________ __ ____Size of Soakage Pit
(Signed) - -_ -_ /6
5-6 U.
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as arc
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 that all fac
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
IN
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT •NS
TOTAL
FIXTURE!
--
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM 'G
POOL
CONTR.
LIST
CHECK
'
Permit No. .___. Date - - -1 -- _ y - `S -S
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith sub ted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Divisior
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept al
building during progress of work.
Owner's Name and Address
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Registered Architect and /or Engin er �__._. __ - .---- _--------- -.__ -_
s /o
Employing Plumber's Name ` __?"'� No. __/_} d 01 Street .I
Location and Legal Description Lot___ __ lock___ yy _.____._____ ______ Subdivision Street and Number where work is to be performed —No _. _U !1_ _ Street_ ft - -
State work to be performed and purpose of building (By Floors )___ - - -_- __ ..-
No 9.0 Street 95
adf
New Building Remodeling Addition._ Repairs No. of Stories
Size Septic Tank Type of Tank_ Capacity Gals
Feet of Drain Tile __Dist. Feet of Tank or Drain Field from We1L
Nature of Water Supply: City—Well ............... -........... _________________ __ ____Size of Soakage Pit
(Signed) - -_ -_ /6
5-6 U.
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as arc
licensed by Miami Shores Village.
Master Plumber.
STATE OF FLORIDA, t
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeare
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 that all fac
therein by him stated are true.
Notary Public, State of Florida
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faul
materials and /or workmanship.
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owners Name and Address Rs_ Leith___ -- No. 490 street. N. E. 94th *St .
Registered Architect and /or Engineer -- -- _ - -�----- . - - --- --_ - - -_ __ -- --
Employing Plumber's Name No.___..__ _______.__ Street.._._--.___ ...... ______
--_---
Location and Legal Description Lot Block Subdivision ...____— .____--___ - -_ -
Street and Number where work is to be performed —No 490 N. E. 94th St. Street —
State work to be performed and purpose of building (By Floors ___.._.._ __ -_ -_
New Building — Remodeling —__ _ - -____ Addition..__._._ Repairs No. of Stories. 0n0
Size Septic Tank.
Feet of Drain Tile_
Nature of Water Supply: City —Well.
Amount of Permit ....
_2_.QQ___
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank___ Capacity Gals
-_Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)-
Plumbing Inspector.
The undersigns ' pplicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws' of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. GIFFEN II US TRIES, INC.
(Signed) -_!�_�
Date Dee. 16 1954.
Notary Public, State of Florida
STATE OF FLORIDA, t - W. Fleming, Trea
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINK•
LAUNDRY
Tues
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N6
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR DEEP
HEATER WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
LIST CONS.
100 -Gal. Tank
CHECK
Permit No
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida,
and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division
of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at
building during progress of work.
Owners Name and Address Rs_ Leith___ -- No. 490 street. N. E. 94th *St .
Registered Architect and /or Engineer -- -- _ - -�----- . - - --- --_ - - -_ __ -- --
Employing Plumber's Name No.___..__ _______.__ Street.._._--.___ ...... ______
--_---
Location and Legal Description Lot Block Subdivision ...____— .____--___ - -_ -
Street and Number where work is to be performed —No 490 N. E. 94th St. Street —
State work to be performed and purpose of building (By Floors ___.._.._ __ -_ -_
New Building — Remodeling —__ _ - -____ Addition..__._._ Repairs No. of Stories. 0n0
Size Septic Tank.
Feet of Drain Tile_
Nature of Water Supply: City —Well.
Amount of Permit ....
_2_.QQ___
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
Type of Tank___ Capacity Gals
-_Dist. Feet of Tank or Drain Field from Well
Size of Soakage Pit
(Signed)-
Plumbing Inspector.
The undersigns ' pplicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Workmen's Compensation Act, being Section 5968, Compiled General Laws' of Florida Permanent Supplement, and has com-
plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be
performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village. GIFFEN II US TRIES, INC.
(Signed) -_!�_�
Date Dee. 16 1954.
Notary Public, State of Florida
STATE OF FLORIDA, t - W. Fleming, Trea
COUNTY OF DADE.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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 that all facts
therein by him stated are true.
NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty
materials and /or workmanship.
aiami fhores9 llage
F L 0 R 1 D A
LUMBING PERMIT N9 771
i
d to t
' Ism:
to inst411 the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
d k d M' Shores Village, Florida
drainage work in Miami
ores 1 age, .
For aj_story *Id building at y, ' ty r 7
Fixtures
Fixtures $
Sewer $
• Ptic Tank / $ / '
Total 464-15"
Village Plumbing Inspector
Received Payment by
OWNER
LOT
BLOCK
SUBDIVISION
.e!
1
, ve
/-,?
,
;2iii $
aiami fhores9 llage
F L 0 R 1 D A
LUMBING PERMIT N9 771
i
d to t
' Ism:
to inst411 the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
d k d M' Shores Village, Florida
drainage work in Miami
ores 1 age, .
For aj_story *Id building at y, ' ty r 7
Fixtures
Fixtures $
Sewer $
• Ptic Tank / $ / '
Total 464-15"
Village Plumbing Inspector
Received Payment by
aiami cJhoresc llage
F L 0 R 1 D A
PLUMBING PERMIT N9 730
Issued to Ciitt,ZSrl .-
t\
Village Plumbing Inspector
Received Payment by
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
'
For a story '� � at'� building at , •---• �-
Fixtures a Q l• � .t i '' 'ik ) ,34. t t; X Q jtl ,,t t ( i :, i ce`
tih Sewer
OWNER
LOT
BLOCK
SUBDIVISION
t
� .
L
j'
J`/
/lttrtiat i ' -
•
aiami cJhoresc llage
F L 0 R 1 D A
PLUMBING PERMIT N9 730
Issued to Ciitt,ZSrl .-
t\
Village Plumbing Inspector
Received Payment by
to install the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
'
For a story '� � at'� building at , •---• �-
Fixtures a Q l• � .t i '' 'ik ) ,34. t t; X Q jtl ,,t t ( i :, i ce`
tih Sewer
aiami cSbores llage
F L O R ID A
PLUMBING PERMIT
/17'cre Date
Issued to /t'
to instl the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a_/story ,4 building at 1t''4 7 / / & '' `?
Fixtures
Fixtures $ el f 0' ) .
Sewer $ Y\ / Ct I P\
Septic Tank / $ / -419
Total $ if I &
Village Plumbing Inspector
Received Payment by
N9 771
OWNER
. LOT
BLOCK
. SUBDIVISION
I ;.
. , ._ e
c
1' ..1
/
d; i a.
aiami cSbores llage
F L O R ID A
PLUMBING PERMIT
/17'cre Date
Issued to /t'
to instl the following described plumbing, in accordance with the laws, statutes and regu-
lations of Miami Shores Village, Florida and the State of Florida, governing plumbing and
drainage work done in Miami Shores Village, Florida.
For a_/story ,4 building at 1t''4 7 / / & '' `?
Fixtures
Fixtures $ el f 0' ) .
Sewer $ Y\ / Ct I P\
Septic Tank / $ / -419
Total $ if I &
Village Plumbing Inspector
Received Payment by
N9 771
MOUNT (RECD
4
A r
SUR.DIV
ADDRESS
nd Specifications h- tofore filed in this
the construction ies strictly with
of ; Florida and with the building • , .n
V This permit may be k
and ,.eci
LICRNra O.
is granted upon the express condition
dons submitted. and in accordance
f Miami Shores Village, and rata and
violation of any of
ding inspecto
E t ' AL PERMIT
PLUMBING
Owner of Building /
Architect and /or Engineer_
Contractor sereelftret_.._
Proposed Location A
This permit is issued to___
the building above described. as appiicatio% Plans
that all facts stated in the application are true and
and compliance with the building laws .f the
regulations of the building department Mi
laws, otdinagcesor rules and reg
In consideration of the issuance to me of `s° peanut.
plans and specifications thereof heretofore by ime submitted,
building ordinances and zoning laws of Miakni Sh ores Vill
Dated__
,r
NOTE: A ehasge j of $ 1.00 will be
A re- inep.aion fee cif 11.00 'On be 0
866
MIAMI SHORES VILLAGE
BUILDING INSPECTION DEPAFITME
1
the proposed construction in strict conformity the appliattioa aid
pliance with all provisions of uilding laws of the State of Florida. all
1 rules and regulations of the , g departm of Miayli Shores V'
application after al ' as '; , from: do
improper bier Inc ids and/
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
SINKS
SLOP
SINKS
LAUNDRY
TUBS
URINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
-
ff
l
!
A -244 5M 5.38
I herewith submit the following plan of plumbing for approval:
Employing Plumber : ,+ .; { Work executed by
For
Address
Plan No
New ❑
Dwelling ❑
Owner or Agent
Builder or Contractor is
Sewer Connections
ROUGH -IN INSPECTION
Ground Rough -In
REMARKS
DIVISION OF PLUMBING INSPECTION
DEPARTMENT OF PUBLIC SERVICE
MIAMI, FLORIDA x r1 19 3
Store ❑
Old ❑ Story ❑
Garage ❑ Apartment ❑
Address
Address
Lot No. 'ti' Block No. Subdivision 1 ' 6
At center of St. ❑ At curb ❑
Date r
Rain Leader
AM P M
Approved by "
Condemned by
Sewer Permit No
At property line ❑ Existing in alley ❑
Date
SEWER INSPECTION
Addition ❑ Remodeled ❑
Hotel ❑ Office Bldg. ❑
REMARKS REMARKS
Existing bldg. sewer ❑
To septic tank ( Existing bldg. drain ❑ To dry well ❑
A charge of $1.00 will be made for correcting any inaccuracies in the foregoing information.
DO NOT WRITE IN SPACE BELOW. THIS IS FOR THE USE OF THE DIVISION OF PLUMBING INSPECTION ONLY.
Date
FINAL INSPECTION
AM PM. AM PM
Approved by Approved by
Condemned by Condemned by
THIS SPACE FOR ELEVATION SKETCH
In alterations to existing work show the old work in red ink and the new in black ink. Letter each stack to correspond
with the opening shown in floor plan or ground plan on opposite page.
A PERSPECTIVE SKETC:
PROVIDED THE WORK C
4
t
) •
• , ,"„
/
. 04_ 4/.0
: WILL BE SUFFICIENT THIS SPACE FOR PLAN SKETCH
°N BE CLEARLY SHOWN
Show location of stacks and horizontal drains inside building, lettering each opening to correspond with the stock con-
nections as shown on the elevation sketch on opposite page. Where ground work is concealed, draw floor plan of build-
ing showing location of walls, partitions, columns, etc., and the location of all horizontal soil and waste pipes, in ref-
erence to same.
Sketch position of building and lot lines in square (which represents an entire city block) , showing on which street
the building and lot faces; also show exact locations of "Y" in street and position of lateral or septic tank. Show
sewer and any change in direction same may make. The purpose of this plan is to have an accurate layout of all
underground pipes for future references.
SOUTH
W EST
NORTH
A
SOUTH
EAST
Remarks:
NORTH
s
Date �J
Legal Description /-4. l - J ,2
Owner / Lessee / Tenant eoait Master Permit # ,;3‘,7e Owner's Address 4 * O �y Phone
Contracting Co. j��,' 9146v Address /,! � 7 � fir/ /v� —
� het 6' � r ���� 33/61
Qualifier ����� £I S S4� - - Phone
State # 4 T' Municipal # Competency # Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL �UMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
6 Job Address 4704), / 6-1"
Tax Foliq// Jai f 7 NA°
Square Ft. Estimated Cost(value) /G i 'i
t
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 ompliance wit all applicable laws regulating construction and zoning. Furthermore, I
authoriz- he above- �?-A contractor do the work stated.
!. � L. —
Signat rp qfowner an • /or Condo e' resi n en
Date : //9/. Z
/ ` JOSEPHINE CMQGI
_
, �.� . _4 e t4 . • .
N.4r ry • s to Owner 1 . “ ---1 : 6 i0ONBMANAA0401130.
My Commission Expi S • '� at91s16
APPROVED:
Zoning
Mechanical
Signa ontractor or Owner- Builder
Date::'? /P/
as to C
y Commission
** * * * * * * * * * * * * * * * **
FEES: PERMITJ a B0 RADON C.C.F. /' NOTARY 5 a TOTAL DUE" L 0 B
Fire Other
Electrical
CONSTRUCTION PERMIT FOR:
[ ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
[`] Repair [ ] Abandonment [ ] Other(Specify)
PROPERTY STREET ADDRESS: 4
APPLICANT:
LOT:
PROPERTY ID #:
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 [ ----^" ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
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(r ()] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ = STANDARD [ , ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH ] BED [ ]
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK: SUBDIVISION:
T' I L
] INCHES
AGENT:
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
TITLE:
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016-0)
INSTALLER /CONTRACTOR
PERMIT # r 3 -
DATE PAID
FEE PAID $
RECEIPT #
A A
p
EXPIRATION DATE:
CPHU
Page 1 of 2
INSTRUCT':
PERMIT" NUMBER
APPLICATION FOR
APPLICANT.
TELEPtior\;.
AGENT
MAILING ALA
BL(■ci: U;
PPOPIIRT1
SYSTEM i rSIGN D
SPECIFICA.TIt
TANK:
DRAINFIELD.
()TFIER.
APPR ()\.'F:
LATE 15_L1 ).
FA(
FA(•
•
J
1
i_
" 1_
J
- -
L /17 \ \//
, , ,
■ 1 i �
d_ ' -
I
. e_
it
is ..
(
1 I I I ..
Lzal_
J
' --1
_�
- _
_ L 0 - t
�r
J=1_
_
J
- I l
-1f"
r
—
_1 _I_I
I -
'__C1
1._
1 "
I -
-
_ rJ
�I - 1 �,�
- .�iF
I
I_
i
1
- � I_
I
I
1
■
a
--
1
_RUI
I I -
` iJ_J__
r 1 - 1] 1-( i I
I 1
I
- r - m r
J_,
_
I
I
T1 I.
a.
• � I 1 I � : C
1
_
- C ,
-
�SCc
(-Qv-
:
_
LLH
- r'
1
1 "
- -_
71__! _i 1-C-1-1_1--
r
'
_
1
_,J_1
17
L
1
1
i
i 1
I - , -
' -
1
- - _-
•>r
^
_y
I
r '
n I - ja (
!
�� I 1
V 1 1-_!_11_1(__
-
•. 1
I�
I l
_
I I
. _I- 1
- -
L
1 _
lJ
11
--
_
1
... 1-11-
}a (
LI
I
1 1
I
J
-
I L 1 IJ
I 1
I
i
.1
I
!_ __L_
_
_
--
_
-
` 1 1
a i.
i%
1
=
�
I
1
': `
►
W J I I
1
I
1 I I
..
� I
Flii
1
'
of
• ._
_
I
1 1 1 !
I_! 1
11
1
r
I 1
■
1,
r411
■)• 1 I
1 1 11
I�
) _
_ .i1
1
1 1
7, I
'
i i
-
pr
b
� 1
I
J
��I JJJ I I
ICJ
I
I
I it I
o i -
,
I _
L
- 1 �
� �
)
I
J I _ I 1
I I
I_ LI
I I_r 1
I 1I
..
1 L' 1
I
!
...
�a
_
fit
_
J 1 1 21
...
.... -
_ �
�
s !
�'
� 'I _
_ ■
L; '_
aJ L
\
EE
A 1
I
1
0 .
1 I
1
1 1 1 1
!
1
min
4
1
_
I l
I
I _
r
I
i
1 1
1
1 -__
_=J
-.
_
l
JP!
r•
_._
-�
_ --
1 ,
l_ I
_
i
��
_0_
J =
- I _ I
i 1
- -! I
■
�
_t_ . __
. _I
1
I L ,
71 = _ 1�
�- `1 l I
1 _
j_
1 r [ 0_i
�.
\.
L
!ERR
-
.1
■ _
I I (
I I - 0._-_--1
l _J_
_ 1 _ 1 _
±- 1 J_
- f _I_l
1
-
# i
•
/'
/ s
1 1
I
-
_
- -
L
a
- _
I> - i - C I
...1i
l
I
L
1
!� T
1
III
■
1
r I_
_
I_
I_
ice;
z :
- -
1
-
- i -
_rt_ _
1 1 I
1
_ I _ �
- �i i_
_ - l. 1_J
I
_ ,
i�i - I
i_i i_J i
\
•
l _
-1
1 I
- I 1
1 " 1
-
-I_ _
1 1
U
1
I I , J
Lll1
I u
7 1___I
1.
' 1
1_
y e-
w / 1=1
1 J
I
■ _h
ii _h
.
1
, i_LI
.1J
J I]
1_'
�I I
( I
!
J
1
■ 1 T I
I
I_1
u
1
1-' L
1 t 1 —
�, 1
_
J
1
1
�.
L
J 1
a
I
I
_
_
■
- mi
[
i
,r,.
3 (j
L.
1
..� I .
LI
CL
L � � 1 _.
- 11
■ ∎ 1
Jl
1 1
[1 1_1
I_
. 1. ' 1�
I
I l l
1
1 I
IJ
I -J , I,.
I I
I .
\
/ :
2H \
Q -
� �
e a L
G 2_
_
1l
U—
_ I
I
I
1
"ti�
"
e
�
.
_ 1 ....
ID-
! ,,
f
i = -1-
s I
_
LI-
�_
1 EFL
1__1
- - J L
1
1
,
1
•
f 1
J 1 11
I
1
I ,�
I I
1
'
_ _
1
I
-' . 1
I_ I-
L _l
1 -
1
J
'
I-
J-
i J
1 1
I 1 1-
■ �
_
- I
- I
_ ._
1
I -
I
_1
— L
1-
�
1
Lr1_
i 3
n . .� \
� 1 -
r - 1�
L 1
F - 1 -_- 1 - 1 - ' -
-
COT
[
l
i J-
i
1J
I
l L _
- �
'
1 11 1 21_11
_I 1 I I_
�1 -
1
J
. I,
_ I
�_ I
�_
L_
.i._
J
1
1 (
1 1 1 1
1J _I .
1 1 � .1
s t
.J _
•
r l _
_
i I_I L
L
_I
I
I t_
w-4-1
-
�c�'
a
oA
_I_I
iJ
J 1 1
1 .
;M
I
Y/I I
I@ 1 1
11
1 1
g `fJ
1
f _
I
1 1 1
1 17
— )
1
-
10
!1(�lI
'
1:.,
,
_i_ c
1
1
J L_
*
-
- - F I
ILL
;
-
4- -1 -
«�.
11
- --
IL
1-I
T A A ,�
ra
,ili�
t -
1
�I_1
�
i L _ If
_ L'r I
!_
I I I
—
__l
_ _L
LJ
I�
J 1
JJ .,
_U__
0__�
■
■
••'L�
/
r
I _
1 1
J 'J
��
_ t1
._
_=L
1
I
I
I
'-I
1 1
I I I
I
J I
r '
�; i
- c 1 I.
I
1
I
J
I I
f
111
Li
L I
_.4
II
- I
JI 1_ _
I
1 - - II
I
J�
- r
0
_ i
1 1
i -
r7
[I
I -
E I I__
1
-1J 1 1
I
(� (
-:_
1 1_I_1
r ;
I
E !
r 1 - I 7--
'
1 I
1
- r r
I 1
I
1
C
_ I
II i
'_
'J
-
I I
J
1.
/
S
` i
I
J �i 1 . (JJ
■
M
- xx
,__J,..,,__„
' l-
„ ( 1 1� 1
I
1 - 1
Ci f l_f rJ ;
- r 1 1 ,.„,...,.L, _
I 0=
71_1_7 1 _ ,-
. . a,,,
..
1
�, 1 - I i ; _ 7 _ . , _ I
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number 4 4
PART II - SITE PLAN
Notes'
Site Plan Submitted by Kda4/eord--e-s
Plan Approved
By
ALL CHANGES MUS BE APPROVED BY T COUNTY r CJBLIC HEALTH UNIT
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number 5744-002-4015-6)
r ;
Not Approved
Date -. Jg ,5
f
c ar/. . County Public Unit
Page 2 of 3