Loading...
574 NE 94 St (4)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 1 02 - 0 ( Job Address , t 57 f ! I` f / sf Tax Folio Legal Description Lo + 3 ¢ ci (v l Historically Designated: Yes State# 95-1 Square Ft. ©6� Notary,&s to Owner and/or Condo Pre 'den My Cfimmission Expi,Ies: t '' P3411111/1/L FEES: PERMIT J ' V'� RADON sident Date tli, DL U 2 7 7Ks2 9 p©7 /-3-6/ Date Estimated Cost (value) C.C.F. l 0 NOTARY 3 APPROVED: Zoning Building Mechanical Plumbing — 3,206 - of c -,cj? O Electrical Structural Engineer Notary as Cottlractor or Or6Ghei�Hui1 My Co Ins. Co. TOTAL DUE No Owner/Lessee / Tenant)( P ' 4 /?/l j'S 5 o 4 `L Master Permit # "WC Owner's Address //j £ 9 '? S phone),/ S - C7 a a Contracting Co. C V I. cf (M, to V1 C, (.S C Address Qualifier C)/I, tAiLICS C,1n, to WI. V4 r SS# 0s ` b e0:6 1 Municipal # Competency # Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTIO l W1f O' A 4 I (,r� ytf�. f/ opi '41 T t 1't +1 t, k 1 17 "p4 11 960 J � ' d 3d dt)‘-c (vet 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. OWNERS 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. for or Owner- Builder Da e 54 Date i� BOND tJ �� CONSTRUCTION PERMIT FOR: [ 4 New System E,t -]}-- Existing System [ _1. Holding Tank [A Repair [ (1-Abandonment [ c1_- Temporary APPLICANT: �� e . 'IOW — / / fic! /hLd/(' Zyal i . / PROPERTY ADDRESS: 5 7a Ph: 5V SF LOT: I p% PROPERTY ID #: _ STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT BLOCK: SUBDIVISION: /J y O';)Gc,'t, i s SYSTEM DESIGN AND SPECIFICATIONS APPROVED BY: i ``� F 4 , DATE ISSUED: !. / ) TITLE: PERMIT NO. / DATE PAID: ! ����; FEE PAID: RECEIPT #: G [ ] Innovative (SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. T [ - ir.) ](GALLONS 3/ 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 DOSING TANK CAPACITY [ ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ] D SQUARE FEET PRIMARY DRAINFIELD SYSTEM R ( ] SQUARE FEET SYSTEM A TYPE SYSTEM: r"] STANARD [ ] FILLED [ ] MOUND [ ] _ I CONFIGURATION: [ ] TRENCH [ BED 1 1 N F LOCATION OF BENCHMARK: 7f; I ELEVATION OF PROPOSED SYSTEM SITE [ ; CINCHES /FT] [ABOVE /SELOWT BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE �a�j [ HEp/FT] [ABOVE /SEL9W] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ "<::: ] INCHES EXCAVATION REQUIRED: [ () ] INCHES O a E SPECIFICATIONS BY: G � % � A TITLE: EXPIRATION DATE: DH 4016, 12/99 (Page 1) (Previous Editions May Be Used) Page 1 of 3 pt. 1: Roalih Dopar mCni pt. 2: Applicant pt. 3: I nstallor /Corsi rac ?o: pt. !: luileinci, E u` :1Cini c CHD INSTRUCTIIIONS: PERMIT NUMBER,: Permit tracising Dumber assigned by CPHII.J. CONSTIKJCI7CN PERMlili PO118: 011.2.ca type of permit, ET "Oner" specify :ty1:12 in nantl. APPLICANT: Property owner's Cur:. name. • TELEPHONE: Te:ep Lone number for appf.icant or agent AGENT: Proper Cy owner's iegal]y autborized representative. MAILING ADDRESS: P.O. Eon or street maifing address for applicant or agent. LOT, DILOCES, SUEDIIVIISIION OT PROPERTY II1Dit: 29 cbaracter nurnl?.^er for property. (CHID may require property appraiser ED 0 or section/towns:lip/range/parcel number) SYSTEM DESIGN AND SPECIFICATIONS: Minimum specifications from Chapter 64E-6, PAC. Minimum specifications from Chapter 64E-6, PAC. OTEIE Otter specifications, such as operating permit requirements, low-volume flusb toilets, variance provisos. SPECIIPICATI1ONS BY: Name of individuai providing specifications. ET designed by a registered engineer must be sealed. APPROVED BY: County Healltil Department (CIH1D) personnel reviewing and approving permit. TANK: DRAIINFIELD: DATE SSUED: Date permit is issued by CIHID EXPIRATION DATE: One year from date issued !Idle system has not been installed. Permits for system repairs become void 3 days from the date issued. , AGENT . f; „'';N / , , ,_,,„, / t c% 1 T'- I ).; iT - '.%RA.r•c:::;' LOT : ei BLOCK: e4-,_ SOBDIVISION: 0 1 111/ f.: • ; ,, • PROPERTY ID #: I/ i'? , ,,/,-\ - r 1 _.n,r,P",, 4 -.- (Section/Township/Range/Parcel No. ,/,' W APPLICANT: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, PROVIDE REGISTRATION NUMBER AND SIGN AND SEjj EACH PROPERTY SIZE CONFORMS TO SITE P : [J YES [ ] NO NET USABLE AREA AVAILABLE: / / ACRES / TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES-TABLE 1 / OTHER-TABLE 2] I AUTHORIZED SEWAGE FLOW: -,) GALLONS PER DAY [1500 GPD/ACRE OR 2500 GPD/ACRE] UNOBSTRUCTED AREA AVAILABLE: 4,;)Cc) SQFT UNOBSTRUCTED AREA REQUIRED: SQFT /- ` ,- c,2 )) BENCHMARK/REFERENCE POINT LOCATION: q fl .../,.(, (c');\ (, 4- -/TP T'''''\ // /Y ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES/FT] [ABOV ELOW], BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: 1'1 SURFACE WATER: FT DITCHES/SWALES: FT NORMALLY WET? [ ] YES V] NO WELLS: PUBLIC: FT LIMITED USE: /% FT PRIVATE: ;/// FT NON-POTABLE: FT / 74- 6 / BUILDING FOUNDATIONS: FT PROPERTY LINES, FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [y NO 10 YEAR FLOOD ELEVATION FOR SITE: e4 FT MSL/NGVD 7 ?) SOIL PROFILE INFORMATION SITE 1 Munsell #/Color Texture c, 4 ci ; Depth to to to to f T /.7%",/ _ // SDA SOIL SERIESi- to to to OBSERVED WATER TABLE: /( INCHES [ABOVE /--f$ELOW EXISTING G ESTIMATED WET SEASON WATER TABLE ELEVATION i INCHES HIGH WATER TABLE VEGETATION: [ ] YES [-/) NO " MOTTLING: [ 1 SOIL TEXTGRE/LOADING RAT i FOR SYSTEM SIZING• u-\,/ DRAINFIELD CONFIGURATION: E 1 TRENCH A BED ( 1 OTHER REMARKS/ADDIT,IONAL CRITERIA: y - = 0- 4015, 10/98 (Replaces HRS-Hefirn 40151age 3] which may be used) . (Stock Number: 5744-003-4015-1) SIT EVALUATED --- OR OTEER QUALIFIED PERSON. ENGINEER'S MUST PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PERMIT # 10 YEAR FLOODING? 1 ( 1 YES [ ] NO SITE ELEVATION: )0 FT MSL/NGVD SOIL PROFILE INFORMATION SITE 2 or Tax ID Number] Munsell pCclor Texture Depth W01' to , to fr [ : 1 to to _ t o to to to 77--- to USDA S0IIRIE 7. RADE. TYPE: (PERCHED / APPARENT2 [ ABOVE/ BELOW)] EXISTING GRADE. YES [yr NO DEPTH: INCHES DEPTH OF EXCAVATION: INCHES /SPECIFY) )1 YfiV DATE:Z_L: ' age 3