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80 NE 94 St (11)BUILDING PERMIT APPLICATION FBC 2001 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit Type (circle): Building Electrical Owner's Name (Fee Simple Titleholder) , ,/e 'c/ e Owner's Address ge-) rJC . erci siie -cf City 4/Aga ..rit State Zip M3 3 Tenant/Lessee Name Type of Work: Describe Work: Submittal Fee $ Notary $,/.' Scanning $ Code Enforcement $ (Continued on opposite side) Gii Job Address (where the work is being done) City Miami Shores Village Is Building Historically Designated YES Permit Fee $ ' ZS Training/Education Fee $ , q 0 Radon $ ( � ,tie; (74/ 415 , County Miami -Dade NO ❑Addition ['Alteration ❑New i 7 iti eJ_ � r t- /tk L) Structural Plan Review. $ a 1 ak 7 0 ;.). 0 Total Fee Now Due $ Li a' FEB 0 5 PAID Permit No. 1 . 2 GOY- 3f _ Master Permit No. Phone # Mechanical Roofing oy ' ' Z - Zip 37/7i Contractor's Company Name 71/4 Cr J�'�})� �4�� Phone # Contractor's Address /f r 3 7, /J of • `' • City /✓'• 44 e State Zip - i T1L ? * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** WSJ l 7,Ps1 Qualifier Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit 2_• Square Footage Of Work: /Repair/Replace ❑ Demolition 04 CCF$ / • 2- 0 CO /CC Technology Fee $ 937 7 Zoning Bond $ 3t7® Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Chc 12/15/03 Owner or Agent The fo egoing instrument was knowled ed before me this (3 day of 20 kt, b l , who is personally known to me or who has produced V j_ E.46 3+n ar 1 • identification and who did take an oath. NOT ''YP :LIC: Sign: Print: My Commission Expires: Signature Contractor The foregoin instrument was acknowledged before me this day of , 20® by /b L tS � hl� who is rsonally known) me or who has produced as identification and who did take an oath. NOTARY PUBLI Sign: 9, r �� ,'' Co; ;'�,' 310N NUMDEI . Print: c • nflo91o94 FlGALf 0 - YSEAL LA;,' iJ'AJAR 4 nIngsitai �� OO ?dMISSION EXPIRES • • My Expiresna.',200 (Certificate of Competency Holder) State Certificate or Registration No. Certificate of Competency No. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** ` * * ** /********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: �,i ' p2' - a ` P lan s Examiner VP i Engineer Zoning 02/05/2004 10:57 DT E L 3056515610 3056515610 11 0 0 SEPTIC DRAIN CO MIR STATE OP FLORIDA DEPARTMENT OF HEALTH =SITE SEWAGE TREATMENT AND DISPOSAL SYSTNM CONSTRUCTION PERMIT PAGE 01 P$RMZT NO. 0. DAT* PAx): / c Pw PAID) RECEIPT Or I . • CO)ETRUCTION PERMIT OR C ] Nov System W Existing System (N a Holding Tank innovat:iva t,X ] Repair (H) Abandonment [N1 Temporary APPLICANT: Q2 ff _ f -� ,C F�Y PROPERTY ADDEEse i to J , 6 . ' . c 4 -, 1 0 s u r' h / . - s / 3 LoTt / e I ' _BLOCK -- SUEDIViszolf: " L f'2l.� e rfi �a 1 . [SECTION, TOWNSHIP. RANGE, PJ.RCZL MUMMER] PROPERTY ID 0, I 1 - U [aR mz It NIUNOlA] SYSTEM NSQS'�' BE CONSTRUCTED IN ACCORDANCE W2111 SPECIFICATIONS AND STANDARDS or 3*CT / ON E 3 1 65, P.S -, AND CHAPTER sSE -6, P.A.C. pEPART?IZ1TY' APPROVAL 01 SYSTEM DOE$ NOT GtJ,AEANT'EE S3AR'TI3YACT'ORY PERFORMANCE YOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL PACTS, MICA SERVED AS A tASIS FOR ISSUANCE OP THIS PEWIT, ISO/RE TEE APPLICANT TO ?MITI' TER Pim at APPLIcATCON. SUCH xoDITzCATTON6 SLAY RESULT IN THIS PtPNtlIT BEING MADE NULL ANn VOID. issukxCN! or THIS PEWIT DOES NOT EXEMPT THE APPLICANT PROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING RE MEND FOR DBVELQPNEN1'r OP THIS PROPERTY. 9YGTXNS DES GN AND SPtCIFTCATXONS 6.. / (L.-1 T t 7 j U 1 G .LLONS / GP PD _SZPTtC TANK /ARRQRTc 'UNIT CAPACITY A t — 1 GALLONS / C.Pb CAPACITY N t ) GALLONS axxxss INTERCEPTOR CAPACITY (MAZIMUM 1C [ 1 QALLoxs DOSING TAME CAPACITY [ ) GALLONS 0 D [ZOO ) SQVA22 FUT PRIMARY DRAI2TPXELD SYSTEM R [ 1 SQUARE 1!'S SYSTE* A TYPE SYSTEM: [ ` � 9TA)TARD [ tT )' PILLED ( ] WOUND I CONFIG ATION, 1 I TREECE [ BBD [ ] ,,,.__ LOCATION OF BNNoMMARE : /I. JO ELEVATION 01 PROPOSED SYSTEM SITE BOTTOM OF DRAIN]"IILD TO BE R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: --/ AE 4016, 13/9s (rage 1) (Previous Editions May Be Used! [ 1 [j1 t 1 fJ,r,. ✓.� r t { ✓. (4..6 0 1 [INCuuE /r1] tABOvz /i!t,ox eammLAPKL 13 [ZNcass /PT] [ABaVE /EELOV BENCEMAkf /REF TILL REWIRED: [ I ] INCNIHS EXCAVATION REQQtREDI [ 1 1 INCURS NSTM1- 1 2 ' IV S1 k iY[ Y;4' l rur W) SCG[L T — ---- UNr i3O From Off'• fib. �T.�iih f ' Lk 1'ER`' OT' ,rLV.'.i �� // ff�.. ^ , t . t . t:l • \ aifitP,i U. Y1 OFi)SLD .': c s CL& ION BED OR T'IT'LE f MULTI - CEAMBERPI]/ Y;li - EEAI o9 I. 1 Mt7LTI- CEAMBERED /IN- SERIES i ] CAPACITY SINGLE TANK: 1 2SO GALLCN3] [ 7 D0926 PER 24 X12 ;! PUMPS ( ) Pan) - Heafth bepartment Part 2 - AppJfcar i Part 3 - Insttger /COfltrbCiO( EXPIRATION DATE: I"1 Page 1. of 3 02/05/2004 10:49 3056515610 4 , • STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number 3 Lf/' - 12 • PART H - SITEPLAN Notes: ' 7 i ®✓ fr 4 0r 't 7 5 7 170c, �' �, z Q r�..! Dm 4015, 10 /96 (Replaces HRS -H Form 4016 which may be used) (Stock Number: 5744-002-4015-6) MR C SEPTIC DRAIN CO PAGE 02 Scale: Each block re • resents 10 feet and 1 inch = 40 feet. ■ ■ ■ ■�■ ■ ■■■ ■ ■■■ ■■ ■■ ■ ■■■■ ■■■ ■■■■I�■■■ ■■■■■■■ ■■ ■■ M■■M■■■■ MMEMNIMMMUEMMEMMEMEMEMEMMU MIPMNUMOMMOMMEMMMEMMENMMEMM ■■i1■U■■ ■■■E ■■ ■■■■■■■ EMM ■■■ \■MIiEG,l MEM EMEN■■ ■ ■■ ■ ■►E, ■■■ ■NWE ■■ ■ /■■■ ■■■■ MMINIMMEMMEMMEMEMMMEMMOMMEMMONM ■ ■ ■ ■ ■■■■■■■ ■■ ■■ ■■■■U +k f MMM MMIIMMEMMEMOMMEMMMINIMMEMMEMMEMM ■■ ■■■■ �, w ■ ■ ■ ■■■ ■■■ ■ ■ 11 ■■■■ ■■ ■■E r1I ■■■■ ■■■■■ ■■ ■ 11 ■■ ■A ■■ MIME MMEMM■■ ■1 ■■ ■•U■rl111■11MO ,,,,,.,rio ■IV!!■■ ■U ■■ MMIN�'�I11I■ MM.Mr■•E■MU ■■ ■■ ■■ 1 1u' ma r 11u1� ■rd . ■■ ■■■■ 1 � ■r ■■11 _ �+n��l■■ ■� ■eel■ ■■■■ IMMEMEMMEMOMMEMMEIMMEMMUMMEMM MMEMMEMMEMMIMEMMEMMEMEMBEMME OM ■■■ ■■■■■ ■N■ ■ ■■■ ■■ ■ ■ ■1■ ■ ■■ 1■■ MI ■■■■I■■ ■■■ ■■■ ■■■■■ ■■IU!1 ■■ Site Plan submitted by:`` Plan Approved _ Not Approved J I` By t �`�'�"+ v- _ , kll t, ..ti, LJ tc e tz ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT County hfealth Departmen Page 2 0f , Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 2/9/2004 Applicant: RENE Owner: ECKERT JOB ADDRESS: 80 Contractor MR C'S SEPTIC TANK Local Phone: 305 - 651 - 7859 Parcel # 1132060130300 Signed: NE 94 (INSPECTOR) Plumbing Permit Permit Number: PL2004 -38 ECKERT RENE ST Contractor's Address: P 0 BOX 693239 Page 1 of 1 Legal Description: MIAMI SHORES SEC 1 AMD PB 10 -70 LOT 1 & LOT 2 & E1/2 OF LOT 3 BLK 3 LOT Fees: Description Amount FEE2004 -1220 Building Fee $175.00 FEE2004 -1221 Builders Bond $300.00 FEE2004 -1222 CCF $1.20 FEE2004 -1223 Notary Fee $5.00 FEE2004 -1224 Scanning Fee $3.00 FEE2004 -1225 Technology Fee $4.37 FEE2004 -1226 Training and Education Fee $0.40 Total Fees: $488.97 Total Fees: $488.97 Total Receipts: $488.97 P4 Z,s_ Permit Status: APPROVED Permit Expiration: 8/3/2004 Construction Value: $2,000.00 Work: REPLACE DRAINFIELD ONLY 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 accepting this permit I assume responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: oy Pa PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 2 ' S Job Address D cD N ` cf S 7 Legal De (e Lessee / Tenant Ct4, �i r lL �- . - 1 9Lj d - Owner's Address f Contracting Co. )0140A�M Qualifier 11W r e Z e f 5 - State # 5677 Municipal # • Architect/Engineer Square Ft. Estimated Cost(value) Signat a of owner and /or C do President 0 FEES: PERMIT 2 j D • RADO APPROVED: Zoning • ° �� otar, , Yti�.,0 Aand arY Q6ARi• President My C "k _,fit : itHIPM 4 IIONTIEL M * C M SSION NUMBER Q C C401261 j MY COMMISSION .EXP. or:P *AUG. $47 1998 Mechanical Building Plumbin Tax Polio Master Permit # 3 Phone Address I3(o t( w w 6211r:51 2Ci �I Phone Competency # / 7 (, b� Ins .Co r Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICA. PLUMBING CHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION ,y Date: 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 informs ion is accurate and that all work will be done in compliance with all applicable laws regulating o struction and zoning. v rthermore, I authorize the above -named contractor to do the work stat re of Contractor or Owner- Builder Notary aEvt6PqpnWW4toPatiflY0Wder Builder My Co la p M l!IONTIEL COSION NUMBER N, ' 4;%;,: Q CC401261 9 r�, ' ^ Qom. MY COMMISSION .EXP. * * * * * *F rLO * Al__ 17.19!8 * ** N C.C.F. NOTARY J TOTAL DUE 3, 54 Fire Other Electrical ngineering STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 1OD -6, FAC CTSTR New System [ System pi ] Existing System [Holding Tank [ ] Temporary /Experimental UCTION PERMIT 9DR: [�¢ ] Repair J Abandonment ] Other(Specify) APPLICANT: ;I O AGENT: DO 4° • PROPERTY STREET ADD( SS: LOT: PROPERTY ID #: [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER) d [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 DESIG1 .AND SP CIF`ICATIONS T 1 ®.0 1") [GALLONie/ GPD SEPTIC T 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 L:› Q FE,EDPRIMARY 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: [, ] INCHES EXCAVATION REQUIRED: [ ] INCHES 0 T H E R . �V� 1 S L •.8 i .. SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: BLOCK: SUBDIVISION: • ;T 7 4 z,,r "'' mac TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744-001- 4016-0) nppuonmy PERMIT # 5,5 DATE PAID �� tJ FEE PAID $ RECEIPT # 9 1 7J EXPIRATION DATE: TITLE: - CPHU 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. Sox 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 U or section/townshi, /range /parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 10D -6, FAC. DRAINFIELD: Minimum specifications from Chapter 100 -6, FAC. OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisnn. SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be scaled. 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. LOT: BLOCK: PROPERTY ID #: THE MINIMUM SET SURFACE WATER: WELLS: PUBLIC: BUILDING FOUNDATION`: SITE EVALUATED BY: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS 95z PROPERTY SIZE CONFORMS TO SITE PLAN: TOTAL ESTIMATED SEWAGE FLOW: AUTHORIZED SEWAGE FLOW: UNOBSTRUCTED AREA AVAILABLE: USDA ,SOIL SERIES': { s 1 7 0 • I°CH FT FT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE'IS SITE SUBJECT TO FREQUENT FLOODING: 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROFILE INFORMATION SITE 1 Munsell Color Textu e SUBDIVISION: Depth to to to to 0 t• to to to HRS-H Form 4015, Mar 92 (Obsoletes previous edifions which may not be (Stock Number: 5744 - 003-4015 -1) [ ] YES (WN0 AGENT: OBSERVED Dr WATER TABLE: --�INCHES [ABOVE , � LO EXISTING GRADE. TYPE: ESTTMA'j•EDt WET4E SON 4gATEIt'TABLE r I, 'car INCHES [ ABOVE / HIGH WATER TABLE VEGETATION: [ ] YES [i] 0 MOTTLING: [ ] YES [ gioyi PERMIT # [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. YES [ ] NO NET USABLE ( /(f ACRES GALLONS PER DAY [ RE S I DENCE S -T 1_1-OTHER-TABLE 2 ] GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] SQFT UNOBSTRUCTED AREA REQUIRED: &f 'SQFT ' Q [INCHES /FT] [ABOVE1BEL0 ENCHMARK /REFERENCE POINT CAN BE MAIN FROM THE P OPOSED SYSTEM TO THE FOLLOWING FEATURES: - DITCHES /S ALES: 6 FT NORMALLY WET? [ ] YES [ kIO LIMITED USE: FT P IVATE: FT NON- POTABLE: ° )S -- FT 10 FT PROPERT LINES: FT OTABLE WATER LINES: /0 FT 10 YEAR FLOODING? [ ] YES [ /JA10 ),' FT MSL /NGVD SITE ELEVATION: '- FT MSL /NGVD J SOIL PROFILE INFORMATION SITE 2 SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: /..„r�1 DEPTH OF EXCIVATION: 3S DRAINFIELD CONFIGURATION: [ ] TRENCH [ WBED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: PERCHED / APPARENT] EXISTING GRADE. O DEPTH: . INCHES DATE: `7 / Page 3 of 3 rt INSTRUCTIONS: PERMIT 0: Permit tracking number assigned by CPHU. APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. BLOCK, SUBD:V S'ON: Lot, block, and subdivision for lot. PROP:ERTY IDO: 27 character number for property. (property appraiser ID 0 o%- eectior'townshipkentjje/ :..-sal number) �zO FT tli i`. _property size itt site coat: r-'s to omitted site plan. accord cet esab'.e a :cam :; : • - Zola - `a: c o: er_cix ;c'va of L , :'vc_' (!ties and prepared :-ocd beck wi _pia public rights-of-way oe etc. :me : o of atacfrm, lcFSeo, - nrtly vj. drain r d ;cites, mr.rshes, cr other such bodies a`wctez. 'Ji\107.S WAYN IIL.JM SETBACKS: .. ?.co rd . to c, almaS( :(S scv,rue Pow t''^ (::.Ji7-rcc_L^, _ :_ "s.) ..r, ,.. 9 � e aeCU'a t . -^ .,:, .;' „ t:; � :. GJ 'A:' .. .. =al .:T._,.. _.. :z! p:'. e _ 2.5C3 g s + per ' Doe r.c :'e _� !vote wc_,_ ,__ . . • o_ .:.. .�. ', ^ ... :._. ^s. c t 1r£ :::i of unoJc oicted 13 .__<anfiels. Lb:cra:io :err.. 75 tope:: :_: Chapter iJD-6, FAC. The aoc%stn.:cted area must be car'.iguos.:, x f.le sin .. ...:'_d. t the location of the benchr a.a. :';sing t, c_ ro ;'o °'a b:cccbtr_.,'c :co dad the sett. " ; :evcticn. Record tho elevation of the proposed system site in re`. -ction (above or below) to the hsttchmc:-`t. cord minimum setbacks which can be mee: to cI: listed features. Aettial r._:asuren :.. - ?us' be recorded or 'NA' ref non applicable features. Features on site plan or within 75 fret of the applicant lc: r be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be verified. FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 yco :: flood elevation for the and actual site elevation. SOIL PROFILE INFORMATION: Two soil profiles within the proposed abaorptioo area to a minimum depth of 6 feet or r :al are required. Soil identification will use USDA Soil Classification methodology (M;uncell colors and USDI coil textures). Refusals must be clearly documented. Provide USDA roil series if available, record "UNK" if the ceri„ a cannot be determined. WATER TABLE: Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent' as appropriate. Record the estimated wet season water table elevation based on site evaluc_iuo, USDA soil maps, and historical information. Indicate if there is :sigh water table vegetation present. Indicate i :' oot.ling io present and depth. SOIL TEXTURE: Record soil texture or loading rate for system oizing. DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must zeal ali documentation submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 S:,73 3 [ +] SNOT: H.1. H.I. H.I. H.I. ' [ -1 SHOT [ 7 SHOT [ -�; SHOT APPLICANT: AGENT: MAILING ADDRESS: LOT: PROPERTY ID #: PROPERTY SIZE: BLOCK: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT Authority: Chapter 381,,FS & Chapter 1OD -6, FAC so SUBDIVISION: s �� PERMIT # DATE PAID FEE PAID $ RECEIPT # APPLICATION FOR: [ ] ) ew System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental [ VeRepair [ ] Abandonment [ ] Other(Specify) TELEPHONE: t 7 6 DATE OF SUBDIVISION: [Section/Township/Range/Parcel ZONING: TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE. PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED] ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [UBLIC go Pe 94 cl- [ J RESIDENTIAL [ ] COMMERCIAL No. of Building # Persons Bedrooms Area Sqft Served [ ] Garbage Grinders /Disposal [ J Spas /Hot Tubs [ ] Ultra -low Volume Flush of ets Other (Specify) APPLICANT'S SIGNATURE: HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4015 -1) DATE: :r Business Activity For Commercial Only ] Floor /Equipment Drains Page 1 of 3 INSTRUCT:DNS: Check type of permit, if "Other° specify type in blank. Property owner's full name. 7EF.EPHONE: Telephone number for applicant or agent. ACEN7: :Property owner's legally authorized representative. IVDDitESS: ?.0. box or street, city, state and zip co-de mciling address for applicant or agent. SU:3071ViSiON: DIRECT:ONS: "?rovide detailed instructions to lot or attach en area map showing lot location. 3f.JILDINCZN:FORiVATION: Check residential or commercial. , • 1 • L..; • -7; • Lot, block, End subdivision for lot (recorded or unrecorded subdivision). :;f lot is not in c reCO:(..f... subdivision, c copy of the lot legal description or deed must be attached. T. O Sa31 Official date of su'odivision r.;corded r ccIaitty plat. hooks (month/day/yer.:) or date lo: originally : . Dividing, an approved iot into two or mere parcels for the purpose of coTyin3 OW:UL1F 2:1E1! s C;f: CCTIEEeMt.: suhciivi••ir. of the charact.er number for proper.y. - 7"7: 1 1 cppr I/ or sec:fent:owns '..?trange/parcel number. usable area of property in t;c: (IrQuarJ factr:3; Cividsr: ".3y /3,560 sT..tcre feet) enciittriive of :.wed cross and pmpared road beds within public rights-of wcy or ease:T.:erns r.n-1 ertehisive of st.:. ino, ntri wet emir z_m-z2es, or other tr,!.Ch bodies of water. Contigt:ous unpaved and nor:compacted rights-of-way and easements no subsurface obstructions may be included in calculating lot area. ViAffER SU??L'f: Check private or public. liKROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road an r iocale in county. type of establishment from Table 0, ,Citcpter 100-5, 7AC. Examples: single fcnfly, single • rii; mobile home, restaurant, Coctor's office. 1\10. :ISIORSOMS: Count all rooms designed primarily for sleeping and those arena enpecteci to im.utinely provide s1eerHn3 accommodations for occunants. 'Thts/ square footage of enclosed habitable arec of dwelling unit, excluding gu carport, enteric 7:cmge shed, o: open 07 fully screened patios or decks. 13ased on outside measurem.en:s for each story of structure. ?SONS: Nurr.ber of p,trsons residing, usin3, or working in ertZolishmen.t. ?or residential estab!ishmer_:, 2 ons pc: bed:col:lam; tissurned. :3US:NESS commercial r,pplications only. Lis: niambe: of employees., r2iftr, 41t-le z:".c.:1:-r, of operation, or G:::::::".P.TermIntion :eciuireci by blet 0, Chapter 100-6, " 7 Var2 each listed fixture with numher 11 or "N.A.,' if no: ree"icabit.. Signaturt. of applicant Or agent. ::Date apnlication one rir.y subrr.itted to anoronirictri : nne Flt A site pirin dirdwn to scrie, rig 301.!T;i.1'.:1117'1.::1 L'aC07C1CC sy.:tern compon.tat.i cr:ci iosa..ien of prs„lciiy, .apnreri cirviriagr, filla .th!!..,,cter.1 • tir if 71. kviLliin 200 tie... of ict.. Notes: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUC R 3 � J Permit Application Number �°' By Plan Approved Scale: Each block represents 5 feet and 1 inch = 50 feet. M M ■■■■■■ ■. ■■■. MM. - - m ■r■ ■ ■r ■■■■■■r .■■■ ■■ ■.■ ■■■■■■■■■■■■..U.■■ ■■■■ ■■■x■■■■� ■■■■ ■■■ ■ ■■1.■■■■ :'m U ■UEI! :' •• ■ mENEE U• • • • ...I ..lul.ul.U••U••::i::■■� _: U • U Ul IIUIU : :U IUIIU ■ r : •• I ■ .M ■.■■■■■■■■■■■II■ : 1.11111111111.111111.11111.1111114101111111. • ■ ••• • ■ :_: :_: :: • •::: •U :: M SSI■UI I : :UI U U•I•00 0i : • • •:: • r: ■■•• ■ • : ■■■■■■ ■ ■ �pp�„ NY= ■ II. .. • . -mom ' . :a.': ::: : :::::� _:■.■■■■ • ■� . : ■ ■ . ■ .M - •:: :U•l•III•U • : :■... ■■ ■ ■■ _ ■■.■■■■m ri it- l ��_ . ►• % ■■.■■■ ■■ I_ _ • ■■■ ■■■■■II■.■I■■■■.■■.:■ • U ■.: : :•: ter NM .■ : ■■■■ ■■ ■■■ ■■■■■ ■ ■ . ■M::■■ ■_ . S... .•. 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ME ■ .. _■ • L t ■ I� ■■ ■ ■ ■■■■ L _ ■�.■ I I � _ I I 11 ■. ■a■ mu ■ I C I . ■■ 1 '— II ■ ■m :■■■■ ■■■■■■ :■■ .. ■l■■■■ : :■=I■■■ :.u. _ ■■.•■■■■ _� -i-� • ■ • M■_ t ■ ■ ■E ..... ■■■M.■ ir ... ■■■■■ ■ . ■.■ .M■ I • • • ■■ Fi1:■■!i � ■ A r �o'r4■■■■■ ■■■�■■■U■ ■■ ■ I mili _L i • • i 0 n - - 1 ! !: L'9 v ' ! ■■ . lim j Immo mmlimmg EN ••• ■ nom um ■ ■■■■.■. il ... al -! e ■ • II■ ■■ ■: •• ■ ■■■■■ ■ v ■■■ • L- I 1 Site Plan submitted by: I HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6) PART II - SITE PLAN TITLE SIGNA Not Approved Date 2 4-7,14971 County Public Unit ALL CHANGES MUST BE APP, ROVED BY THE COUNTY PUBLIC HEALTH UNIT Page 2 of 3 Scale: Each block represents 5 feet and 1 inch = 50 feet. 1 r L I 1 1 ■ 1111■ : 1111 1 + _I_ L ■ L 1 I- - -I- ■■ 1 J J II MUM • II i . � ■ I • ■ ■ m ■ : ■■: ■ ■ • 1111■■■ MUM • - ■■ • ..NOMM NO MMOMMEMM IN MMOIMMEMEN ma ' CI ::' ii MO 11 5 ■ J J1J I 1 i • • a _ L . • i Ira E t U L_J ■ ■■ OW Notes: APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUC Permit Application Number STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES J_ _1 ,.■ :_ I _I - 1 ._I_ _ i r 1 --- 1-- -4±4 - -- = -- J I ' 1 J - 1_I _ -- - 1 I r I_ _ 7 J I� ■ 4 LL L Vii_ _ JT J- , 1 - ■ ■ ■ ■ ■: I i Ti- I I II 1 �- E ■/ ■■■ ■ Ire H - - -I _JD .* -- --- - -F- -- L-- ___ 11 1111 1 I I 1I ! ■ .. ■ - ■ J ■■■■ ■ C1111I ;-1 ;-1 111111 Ili ■ .. :: . :: i 10 1 II = J. -I ■ ■ ■■ ■■■ ■ ■ 1 • SS • ■ 1■ ■■ ■11.11■ ■■■ ■ ■ ■■ = �i�iiii = . . 11 1 ' ■ ■ ■■ . ■■ ■■■ ■ ■■ ■ ■N. ■ ■■ •s ■ ■/ ■ 1111■■ ■ 1 ■ ■111.1 f ■■■ • ■ ■ ■■r■■■■ ■ 1111■ 1111■ ■� ■ ■ ■ ■ ■ ■1111■1■ ■■■ U m • 1■1111 ■ ■_■ IM■■■■■� 11111li1113!!ii! ■ ■. 1111 ■ ■■■.�.■ ■ ■ 1111■ ` ■::■■ : ■ E■■:"E: ■: 1101011 ■1 1/ ■■ 11■ i ■■ ■■■ IE E� ■■ r ■1 ■1111■■ ■. ■.... ■..■. ■.1 ■ ■1. ■ ■.M ■■■ M. ■. ROM ■..■■■ ■1. M ■..■■. ■. ■ ■ ■■■■MOO:■ = E :E :: :■■■1111■■.■ . ■__■■� ■■ • •■•••••1■ X•11014 1n N■ ■■I eE• •1111111111111•••••••••••••••1111 •1111111111111•••••••••••••••1111 :■n■■=■� OW • ■■■■■■tfG�NTEM■r MAMA ►aW WIN MOMMO ■■■■■■■■■■■/ MMOM ■1■■■■ • •11••••••••11111110•1110•111•• !1111■■■■■ ■■1■u:■■■■■ ■11 ■■■■ ■■ ■■■■ ■ ■■ ■ Site Plan submit by: Plan Approved By PART I1 - SITE PLAN /SIGNATURE Not Approved • RMIT , ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744 - 002 - 4015-6) I I J I - t Jam_ �j ThT _1 1 1 f I 1__ _ L _ I i_ -l. i 1 - � - _1 u� - I. i( � I � I I L _ ■ 1_ _J..__IIL 11'J _�_ L. IL I I �� 1 - - J �_ r 11 } � 1 I I _C 1 f i 1_1 � . 4 1 � j _: 1- 1 I : Lh 1 I L I 1 . _ L... I I_1 �. I 1 C - 11 1 + . I II 7 11 I - I _L. _ ■M■ J -_I J Z I "11 1 � 1! } r f-� I -I- J MEM I - 1 -1-1 i- 1 J I • r I i 1 ■IR Li I - I I_ I_ __ L ■■ - . J _ TITLE Date Page 2 of 3 County Public Unit ,ic e Permit No - Application is hereby n:acie 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. ~G= tG } c > v ' Street -7 '.' Owner's r Wraer s Name and Address _ Registered Architect and /or Engineer ____ —__ _ Employing Plumber's Name_( l�� ► i C �' New Building _._ Remodeling_ . Addition_- Size Septic Tank Feet of Drain Tile 1 1 Q _ Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ( Signed) - `-' —`-=-r Date _.:72 I StreeF _ 2 1- ' 't Location and Legal Description Lo _____— _____________ —_ _ -_--_— Block • Suubdivtsio ____ _ Street and Number where work is to be performed— No. .___ 9r—C ._ 4 • E • Street 1 � - State work to be performed and purpose of building (By Floors)_ Repairs No. of Stories. Tvne of Tank Capacity Gals p Feet of Tank or Drain Field from Well _ Size of Soakage Pit The undersigned applicant for this building permit does hereby certify that he understands and accepts If ob 'gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P anent 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 thie 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. l I (Signed)._ 04 Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared Lf —10 —6/ 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 Plumbing Inspector. aster Plumber. NOTE: A re- inspection fee of $L00 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 TUBE 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 � -.- ,ic e Permit No - Application is hereby n:acie 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. ~G= tG } c > v ' Street -7 '.' Owner's r Wraer s Name and Address _ Registered Architect and /or Engineer ____ —__ _ Employing Plumber's Name_( l�� ► i C �' New Building _._ Remodeling_ . Addition_- Size Septic Tank Feet of Drain Tile 1 1 Q _ Nature of Water Supply: City —Well Amount of Permit $ STATE OF FLORIDA, COUNTY OF DADE. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ( Signed) - `-' —`-=-r Date _.:72 I StreeF _ 2 1- ' 't Location and Legal Description Lo _____— _____________ —_ _ -_--_— Block • Suubdivtsio ____ _ Street and Number where work is to be performed— No. .___ 9r—C ._ 4 • E • Street 1 � - State work to be performed and purpose of building (By Floors)_ Repairs No. of Stories. Tvne of Tank Capacity Gals p Feet of Tank or Drain Field from Well _ Size of Soakage Pit The undersigned applicant for this building permit does hereby certify that he understands and accepts If ob 'gations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida P anent 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 thie 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. l I (Signed)._ 04 Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared Lf —10 —6/ 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 Plumbing Inspector. aster Plumber. NOTE: A re- inspection fee of $L00 will be made when such re- inspection is made necessary. by improper notice for inspection, or faulty materials and /or workmanship.