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501 NE 94 St (2)OWNER'S AFFI be done autho APPROVED: Zoning PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date "1r Job Address S©\ M C I ( Tax Folio 1 5- / 1 D �� D � C Legal Description I. 4 Of I ) 1 1 .r.5 ,4„ T /' Owner / Lessee / Tenant r c`5i2t).NJ Master Permit it ( � Owner's Address Phone 0 501 A) E 9 LI S7 / Contracting Co. 1" ` 2 -r e -r e - Address (, 3 2-Z c� 7 ,_,S . e.-T 6�IfZWheV1 M " Qualifier M tC- -Q1_ nil c? kly SS# / Phone qWe (0q 1 - State # Municipal # r! 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 a> (2A'o� c Square Ft. , O Estimated Cost(value) 1 (3O0-0`CD 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. VIT: I certify that all the foregoing information is accurate and that all work will pliance with all applicable laws regulating construction and zoning. Furthermore, I ab•re -named contractor to do the work stated. Mechanical and /or Condo President 8-C; ',/// 44 ors N ary as to Owner and /or Condo President My Commission Expires: FEES: PERMIT 6 ` " RADON C.C.F. // 0 Signature o Date: Contractor o er- Builder Notary 's tc'Contrac.or,or Owner- Builder My Commission Expi 6?,' *,{r ,AMLGfr %sM 11 , ,mr coAMM [XP. 3- 17 -96 G BONO.wp BY SERVICE INS CO * * * * * * * * Op ,� * NO C£ f NOTARY 0 a TOTAL DUE Fire Other Buildin: Electrical Plumbin Engineerin CONSTRUCTION PERMIT FOR: [ ] New System [ ] Existing System [ ] Repair [ ] Abandonment APPLICANT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: SYSTEM DESIGN AND SPECIFICATIONS T [ A [ N [ K [ L D FILL REQUIRED: [ ] INCHES 0 T H E R APPROVED BY: DATE ISSUED: 4 .� � ✓.. P 1� STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS E Chapter 10D -6, FAC BLOCK: SUBDIVISION: • [ [ ] Holding Tank [ ] Temporary /Experimental ] Other(Specify) AGENT: SPECIFICATIONS BY: TITLE: HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001-4016 - 0) 9 PERMIT # DATE PAID FEE PAID $ RECEIPT # - Pa) [ 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. ] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] '] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ D [t /''] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH f ] BED [ N F LOCATION OF 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 EXCAVATION REQUIRED: [ ] INCHES TITLE: ommuLnnicomunnmon [ / 1'2 2 p CPHU mss/ . . e EXPIRATION DATE: ] 211 Page 1 of 2 INSTRUCTIONS: PERMIT NUMBER: Permit tracking number assigned by CPHU. 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. (CPHU may require property appraiser ID # or section/township /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D-6, FAC. DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed. APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date issued. I I I 1I I' ,_ 1 1 1 !_ 11 _ __1_1_1__,__, 1 1 1_ 171 I_ 1 1 i t –I I , I 1 t , 1 ; . li II it 1 I _ I_ _' 1 I1 Ili li II – U inc 1 1 In i I I I' 1 I ' I 1 I I ' I I 1 I I i I � 1 I I i 1 1I _ i 1I' l `-1, _ 11 I_1 i_ I F-I l I I 1 � 1 I _I U II uh( 1_I_I I i -!!1-n!-; ! � �1 . I t I 1_ 11_ � I Site Plan Submitted by Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 9 /? PART II - SITE PLAN Notes -IRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) 'Stock Number: 5744-002-4015-6) (73r SIGNATURE Not Approved ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE Date q °"2-9 4 4 3 County Public Unit Page 2 of 3 ■•..0 ■ • *a ■t1■ ■ a•U■U I 1 IU II* •U U * ■■er I / Iip ■ ■ ■HhIlli: I I 1 a 11 1 J - - � r • 5 _0- II 1 1 1 ; i ■11� �! 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I t I 1_ 11_ � I Site Plan Submitted by Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 9 /? PART II - SITE PLAN Notes -IRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) 'Stock Number: 5744-002-4015-6) (73r SIGNATURE Not Approved ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE Date q °"2-9 4 4 3 County Public Unit Page 2 of 3