DRAIN FIELDPERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
(OWNER TO RETAIN COPY)
Date !'".,0- 27,dJob Address / t/ 1 3Dr , ' `
Tax Folio // 5 ?I I /ii
- 9 ?J
Legal Description/ W ii / � � id/ Master Permit # j i7 /
Owner / Lessee / Tenant kfilP-
Owner's Address / f Y f�6� 'eJ Phone 75 to() =.
Contracting Co. Z,KiAJ) j.; . 4 'i E Address / 711 ��° e -'1 -7 73/69
Qualifier 4 el�i//f("4 l J� / f P� SSjk ? Phone ✓ L - �'
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SIgnatur cf Dwfi`er an ' Condo President
Da-e�
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PERMIT FEE: APPROVED: Fire
3 1 0,66
State# Competency 1 �� 4‘,)
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
WORK DESCRIPTION 42/61/4) -
Signature
Date:
Ins. Co.
Other
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
Square Ft. Estimated Cost //d4
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 k -all the foregoing information is accurate and that all work
will be d e in •gip :nc � applicable laws regulating construction and zoning.
Furthcirmo I th•.ize t esov: "awed contractor to do the work stated.
of Contra or or Owner - Builder
a
Not y a to Owner and /or Condo President fota as to Contractor or 0 ner- Builder
My Commission Expires: WO / ,, r y Commission Expires: �j ///
Zoning Building Electrical
� l Lneering Mechanical umbii� ` E
Owner's Agent
Date of Application
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
zthfil
Type of
Establishment
Authority: Chapter 381, FS
Chapter 10D -6, FAC
Permit Application Number
PART I - APPLICATION
Name of Owner
Mailing Address of Owner `a .53
This Application is for: New System Repair
Type of No. Bedrooms
Residential (each dwelling unit)
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744 - 001 - 4015 -1)
TOTAL FLOW =
Telephone Number
Heated or Cooled Area
(each dwelling unit)
71%:(
uilder
Telephone No /4 2 7 ege7_
Agent's Mailing Address
Property Street Address / ,f g ii/ 4 —
Lot No. Block No. Subdivision Date Subdivided
NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION
Existing System
Sewage Flow Sewage Flow
(Gallons per day) Based On
No. Dwelling Sewage Flow
Units (Gallons per day)
ft
ft
Exact Directions to Property
AUDIT CONTROL NO. Applicant's Signature ��� C.)
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