746 NE 94 St (3)c .
Date Job Address
Legal Description / �
Owner/Lessee / Tenant /` �rl ' o A E/1-/
Owner's Address S /9/1
Contrac
C tS NON .> r/G 7,:c NIc
Quahfi 8c112
Pho li l g 1
Competency # Ins. Co)
Address
State # #€ v I V ESS `f' Municipal #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one):
WORK DESCRIPTION
Square Ft U Estimated Cost (value) i DO UD
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 abo - - ed contractor to do the work stated.
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
7 y Tax Folio //— 3 / - /
BUILDING ELECTRICAL LUMBING
PG c neK
Y�i91.X� -itJ / Goolp
1V otary as to Owner and/or Condo President Date
My Commission Expires:
S AL
° �COI�MI
• CC401231
7, � °'"' (p My COMMISSIOPo •2X1
COrr�e A19C;, 9no?,
MI
FEES: PERT - 3 — RADON
APPROVED:
Zoning Building
Mechanical Plumbing
C.C.F.
Historically Designated: Yes No
Master Permit #
Phone
&12.t//CE: Address ( 00 W G ��
Address
Address
MECHANICAL ROOFING PAVING FENCE SIGN
Signa 1 e •f Contractor or Owner -Bui
Notary as to Contractor or Owner- Builder
My Co u i • sion,Exp' _
go ,s, reP F
kwo Ai d�-Po EL
� CO S SI ®rEta
•, ' ;� a CC401261
Q` � l;;Y G OL`.9MISSIOPI EXP.
OF F 17 1098
20
NOTARY
Electrical
r
Date
BOND 3e
TOTAL DUE 3 W Zz)
Engineering
CONS RUCTION PERMIT FO .
(pi New System 11,
[� ] Repair
APPLICANT:
PROPERTY STREET ADDRESS: Q�� 7,14c44
LOT: F� BLOCK:
PROPERTY ID #: 8/ [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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 SPE F
T [/® -W] GAL / G D] EPTIC TAN /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: [ ]
SPECIFICA APPROiI J ):
0
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
isting System [, olding Tank [ Temporary /Experimental
Abandonment [ 'Other(Specify)
SUBDIVISION: e ms^
^: .:.�"'
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
AGENT: � A / - 3_44 / C.
TITLE:
CPHU
EXPIRATION DATE: 7-0 fe
PERMIT #
DATE PAID
FEE PAID
RECEIPT #
D [ 3C' ] UARE FEET- PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ]
I CONFIGURATION: [ ] TRENCH [ BED [ J
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCH RK /REFERENCE— PA.ZNT
E BOTTOM OF DRAINFIELD TO BE [ ac) [INCHES/$T] [AB0 /BELOW] BENCHMARK REFERENCE POINT
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [3 ] INCHES
$ £ •c '
vzs
��
PART II - SITE PLAN s`
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number 9g _ e_-(Rs(-/
Scale: Each block represents 5 feet and 1
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Notes: 70
Site Plan submitt
Plan Approved
By
inch = 50 feet.
Not Approved
dip , e9 c f ,s? - r - 5 / G — c -,
4E- v 4A161 - J'AN6 (
County Public Unit
ALL CHANGES MUST BE APPRO BY THE COUNTY PU`:ILIC HEALTH UNIT
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4015-6)
2'
TITLE
4, ,,,o 2
Date
Page 2 of 3
1-
APPLICANT:
LOT: BLOCK: v 9 SUBDIVISION: f -(sD5
PERMIT #
STATE OF FLORIDA -
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
AGENT: a 1 L. J j'""t
�c
( ; -o9S(
PROPERTY ID #:1 ,5,9000 , 14_3 16 60 [Section /Township /Range /Parcel No. or Tax ID Number]
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: � )
AUTHORIZED SEWAGE FLOW: 4.60u
UNOBSTRUCTED AREA AVAILABLE: tx))
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
SOIL PROFILE INFORMATION SITE 1
Mansell # /Color Texture Depth
\. 6 r to CD'
to
to
to
to
to'
to
to
to
USDA SOIL SERIES:
OBSERVED WATER TABLE: INCHES [ABOVE /
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ] YES `[ NO
SITE EVALUATED B :
YES `[ NO NET USABLE AREA AVAILABLE: ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
+ s
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used
(Stock Number: 5744 - 003 - 4015 -1)
[INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: FT DITCHEk /SWALES: F NORMALLY WET? [ ] YES\ NO
WELLS: PUBLIC: FT LIMITED USE: .) � FT PRIVATE ? `N FT NON - POTABLE: Vi ' FT
BUILDING FOUNDATIONS: -S FT PROPERTY LINES: S FT POTABLE WATER LINES: FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES ] NO 10 YEAR FLOODING? [ ] YES '] NO
10 YEAR FLOOD ELEVATION FOR SITE:
FT MSL /NGVD SITE ELEVATION: ' ).D FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture
USDA SOIL SERIES:
Depth
to
to
to
to
to
to
to
to
.1
i
BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
/INCHES [ ABOVE / BELOW ] EXISTING GRADE.
MOTTLING: [ ] YES NO DEPTH: INCHES
1 .0 • DEPTH OF EXCAVATION: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH ] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA: `�- . • -
/ /1
, /,;(...
,rr '! • -. r
DATE:
P
Page 3 of 3
BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
Lot
MIAMI SHORES VILLAGE, FLORIDA
DATE '' °-c 19
PERMIT
B1
N? 7183
Work to be performed under this Permit
5
v � .
Contractor's] , <
License No.
r
U
Subdi-
vision
Address of { Value of Amount of
Building r Project $ 1� Permit $
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica-
tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any
plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked
at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this
permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and
regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents, servants or employees.
Signed INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ao
cepting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER
BY AUTHORITY
ABBOT