785 NE 95 St (3)3
x•?MllT AIFIFILIIECATIION FOR MIIAMII SIHIOIIBIES VIIILILAGIE
D 1/24/95 Job Address 785 NE 95 STREET Tax Folio
Legal Description
Owner / Lessee / Tenant DREYER Master Permit # 3 7 3/
Owner's Address 785 NE 95 STREET, MIAMI SHORES 33138 Phone 756 -0924
Contracting Co. NORTH DADE SETPIC TANK Address 800 NW 111 STREET, 33168
Qualifier DENNIS NEVILLE SS# 267 - 97 - 6375 Phone 754 -3375
State #025836 -8 Municipal # Competency # 12842 Ins.Co. TRAVELERS /ESIF
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL UMBIN MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION INSTALL DRAINFIELD
Square Ft. 200 Estimated Cost(value) $1150.00
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO
SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will
be done in compliance with all applicable laws regulating construction and ,. :ig. Furth re, I
authorize the above -named contractor to do the work stated.
;5,7)
Signature of owner Condo President
Date:
Notary as to Owner and /or Condo President
My Commission Expires:
APPROVED:
Zoning Buildin
Signa :re of Contractor •r Owner- :uilder
Date:
Notary as to Contractor or Owner - Builder
My Commission Expires:
VARY P19 • 4Y ii tY�tY * " ^7°
GA
. EDF ®R 1117
�QR6& rf ;r; :QD.•,i
CCPAPAMPOV EX ?' &FS mile t9 P:CT
e n2a tk:v rtueKersraav c� nss t�ss ,v e :•::r: �:�:�::::� 1u�•:s tr, ��•:;
FEES: - 2 k) RADON ,��$t . NOTARY EONDE} .:6991f idit
Fire Other
Electrical
Mechanical Plumbin Engineering
APPLICATION FOR:
[ N] New System [ N] Existing System [ fl Holding Tanis [ N] Temporary /Experimental
[ Y ] Repair [ N ] Abandonment [ Other(Specify)
APPLICANT: DREYER
AGENT: NORTH DADE SEU2IC TANK
MAILING ADDRESS: 800 NW 111 STREET, MIAMI 33168
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:
DATE OF tefore 72
SUBDIVISION.
PROPERTY ID 0: [Section /Township /Range /Parcel No.] ZONING:
PROPERTY SIZE:
PROPERTY STREET ADDRESS: 785 NE 95 STREET fl 33138
fx >
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
STATE OF FLORIDA PERMIT
,
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID /
ONSITE SEWAGE DISPOSAL SYSTEM! FEE PAID $ �t`I
APPLICATION FOR CONSTRUCTION PERMIT RECEIPT 0
Authority: Chaptee 381, FS 61 Chapter 10D -6, FAC
BLOCK: SUBDIVISION:
SFR 2 BEDROOMS
2
3
4
N
[ RESIDENTIAL [ ] COMMERCIAL
[ ] Garbage Grinders /Disposals ] Spas /Hot Tubs
[N] Ultra -low Volume Flush To ets ] OtF r (Speciff
APPLICANT'S SIGNATURE:
HRS -H Form 4015, Par 92 (Obsoletes previous editions which may not be used)
(Stock Humber: 5744- 001 - 4015 -1)
TELEPHONE: 756-0924
784 -3375
ACRES [Sqft/43560] PROPERTY WATER SUPPLY: [ ] PRIV %,TE tXX] PUBLIC
Unit Type of No. of Building 0 Persons Business Activity
No Establishment Bedrooms Area Sqft Served For Commercial Only
1N ] Floor /Equipment Drains
Page 1 of 3
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STATE OF FLORIDA
DEPA TMEHT OF HEALTH AND REHABILITATOVEE SERVICES
AiPPLLOCATOON FOR ®ROSOTE SEWAGE D1SPOSA0_ SYSTEM C®NST UCT00A PER MOT,
Permit Application Number Lira-
t.I 1' J iII
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III'!�II1 1, • i L_I C T--
I I I I! r I _ 1 L - 1 I _LI
Notes:
Site Plan submitted by:
Plan Approved
By
PART 00 - SOTE PLAN
Scale: Each block represents 5 feet and 1 inch = 50 feet.
- T 1 . J H-H
►- ! - . _ _ r -Wk 141 ' X
r` -l! -� L 10 4- V- '- 1 L -
.
-� 2_ ■■■ L w I I - I- I_
OLD SYSTEM OVERFLW®IIING
DREYER: 785 NE 95 STREETQ 33138
r
SIGNATURE
FIRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744 - 002 - 4015-6)
Not Approved
ALL CHANGES MUST 181E APPROVED BY THE COUNTY PU
f3
0_OC HEA0_Th UMOT
Page 2 of 3
TITLE
Date /' 51-
County Public Unit
CONSTRUCTION PERMIT,,��F��R•� "'
rV/) New System [, ? ] ' • xisting System t' 1 olding Tank C V / 1 Temporary /Experimental
[ ] Repair [/' Abandonment [yXOther(Specify)
APPLICANT: � AGENT: P-4(c)6,Z74.4
PROPERTY STREET ADDRESS: ' ,pi-7,44E27 4,
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 HEIN(MADE NULL AND VOID.
SYSTEM DESIGN AND SPECIFICATIONS "
ON / GP1� SEPTIC TANI /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
[GALLONS / GPD] CAPACITY MULTI-CHAMBERED/IN SERIES:[ 1
GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
T [ ]
A [
N [
K [
D
R
A
I
N
F
I
E
L
D
( 10 ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
[ ] SQUARE FEET SYSTEM
TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND
CONFIGURATION: [ ] TRENCH [ ] BED [ ]
LOCATION OF BENCHMARK:
ELEVATION OF PROPOSED SYSTEM
BOTTOM OF DRAINFIELD TO BE [
FILL REQUIRED: [
O a
T 0 /di I
H
fe., -
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:/- 2.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION
Auth ?rity: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK: SUBDIVISION:
GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [
] INCHES
p a s C '�� � ... /1<°
� "
[ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be V)
(Stock Number: 5744 - 001 - 4016 - 0)
[APPLO CART
ITLE:
Y
PERMIT #
DATE PAID
FEE PAID
RECEIPT #
[
]
EXPIRATION DATE:
]
HU
/-
y
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number assigned by CPHU.
APPLICATION FOR: ("neck type of permit, if "Other" spa: ify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
n_ :1:... ., 1.., a ii,� CIF L`:1:....1 , s,noftipr
AGENT. ��.i:r r� .. ..�: .� .. .. "-r _ _
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 N or section /township /range /parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 1OD -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10Dfi, 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 scaled.
APPROVED BY: County Public Health Unit (CPHU) perfume! reviewing and approving permit.
DATE ISSUED: Dote 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.
MORTGAGE LOAN DEPARTMENT
609 Congross Bldg.
MIAMI, FLORIDA
EG
Mr. A. H. McGregor
Miami Shores City Hall
9528 N. E. 2nd Ave.
Piiami Fla.
Gentlemen:
INVESTORS SYNDICATE
E S T A B L I S H E D 1 8 9 4
MINNEAPOLIS, MINNESOTA
In res Case No. 09=023914
James F. Hardiman
785 N. E. 95th St.
We shall appreciate your usual prompt attention.
Very truly yours,
INVE.:TORS SYNDICATE
' July 31 1910
We are enclosing herewith FHA Form No. 2218 e Certificate of
Inspection of Private Sewage Disposal System. Will you kindly
execute this form in duplicate and return to this office in the
self addressed stamped envelope enclosed.
LITHO IN U.B.A.