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1201 NE 97 St (13)Date 3/04/96 Legal Description Historically Designated: Yes No Owner/Lessee /Tenant Owner's Address 1201 NE 97 STREET, 33138 Phone 759 -2557 Contracting Co. NORTH DADE SEPTIC TANK Address 800 NW 111 STREET, MIAMI 33168 Qualifier DENNIS NEVILLE SS# 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). MIXEDIXIMIXELECTRECAZ PLUMBING 1111ZEIMISTCAMXIIDOCIKESIVOMINIVUXERNXECXYLIM WORK DESCRIPTION INSTALL DRAINFIELD Square Ft. 400 WARNING TO O'' c NER: 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 WITI-I YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.) 2 t''S: PERMIT PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 1201 NE 97 STREET BROWN 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 an laws regulating construction and zoning. Furthermore, I authorize the above-name ' / LYY Signature of owner and/or Condo President Date RADON �+ _ Nat as jciOwner and/ r C hdo P sident Date My Commission Expires [t[[w [[[[[ .,w,sc[[[[[[[[<,[[ w,st,[[[t[s v-, -< ` P ° 6 , J. F rider No'arjFut.1 ;c , cf.l• Car ii ssion No. Oi:it :07 ,`< oF Fl9 N y Cormn : co Ezsir,;;. ; / ' • ,' ;> 4 >? 1•EO0- 3•ROTARY • FL. Jay p -. a Ear,' Co. ; , eateruartaaaateteteera eater eet reteere C.C.F. Tax Folio Estimated Cost (value) $1100.00 as to Contractor or Master Permit # Signat of i at all' acto of Contractor or Owner -B My Commission Ex qes , Co;ji :i. .S oFFt My Corami.;c,r.... - V?. 1- E03- 3•AOTARY. Fla ?Zcs ` .7i x ti L :c;c3 Co. 'lateeetee eeeteftae:.: is eiceeiee, itemyteee: < NOTARY TOTAL DUE ork will be done in compliance with all applicable to do the work stated. ider wnerduilder JJ Date Date APPLICANT: PROPERTY STREET ADDRESS: LOT: PROPERTY ID #: SYSTEM DESIGN AND SPECIFICATIONS F LOCATION OF BENCHMARK: ELEVATION OF PROPOSED SYSTEM SITE [ E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED: [ ] INCHES 0 T H E R SPECIFICATIONS BY: APPROVED BY: 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 BLOCK: SUBDIVISION: AGENT: PERMIT # DATE PAID FEE PAID $ RECEIPT # CONSTRUCTION PERMIT FOR: [ ] New System [ -] Existing System [- ] Holding Tank [.. ] Temporary /Experimental [ ] Repair [: Abandonment [- ] Other(Specify) [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. ] [GALLONS /. GPO] ' SEPTIC TANK /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] ] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] ] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D [ ] SQUARE FEET.PRIMARX DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ STANDARD [ FILLED I CONFIGURATION: [ TRENCH BED N • HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016-0) ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ INCHES TITLE: TITLE: CPHU (,;-- ] MOUND [ ] [ EXPIRATION DATE: Page 1 of 2 : • • .................. •sE: :2 - • ;• :b.: ..T. . ...... ■-; ••• • •;:u: • ______________________________ ___ __a...- ®__.- ...._.- _- ......- __....___PART H - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. Notes: Site Plan submitted*: Plan Approved By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number ' �! SIGNATURE Not Approved /� ALL CHA GES fUSY BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not bg usbdl (Stock Number. 5744- 002 - 4015-6) TITLE Date County Public Unit Page 2 , c): 3 LOT: PROPERTY ID #: BLOCK: SUBDIVISION: 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: UNOBSTRUCTED AREA AVAILABLE: ;,y "- ? y BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS [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 DITCHES /SWALES: FT NORMALLY WET? [ ) YES [ I NO WELLS: PUBLIC: FT LIMITED USE: " FT PRIVATE: FT NON- POTABLE: FT BUILDING FOUNDATIONS: FT PROPERTY LINES: FT POTABLE WATER LINES: FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES V ] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT \M /NGVD SOIL PROFILE INFORMATION SITE 1 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS Munsell # /Color Texture Depth to /2 to to to to to to to to USDA SOIL SERIES: [Section /Township /Range /Parcel No. or Tax ID Number] 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 OBSERVED WATER TABLE: INCHES [ABOVE/ BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES ['] NO MOTTLING: [ ] YES ( NO DEPTH: INCHES SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: ; DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH [; -] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: SITE EVALUATED BY: r AGENT: HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 -003- 4015 -1) PERMIT 1 10 YEAR FLOODING? ( ) YES [ ] NO SITE ELEVATION: c', FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth to to to to to to to to to USDA SOIL SERIES: DATE: ,- Page 3 of 3 T¢_ S - C7: • C'_ , .LSD APPLICATION FOR: [ ] New System [ ] Repair APPLICANT: AGENT: MAILING ADDRESS: 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 ] Existing System ] Abandonment 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: PROPERTY ID #: PROPERTY SIZE: BLOCK: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 ] Garbage Grinders /Disposals ] Ultra -low Volume Flush Toilets APPLICANT'S SIGNATURE: ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE [ ] PUBLIC SUBDIVISION: ] Holding Tank ] Other(Specify) Bedrooms Area Sqft Served ,/ HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4015-1) PERMIT # DATE PAID FEE PAID $ RECEIPT # ] Temporary /Experimental TELEPHONE: DATE OF SUBDIVISION: [Section /Township /Range /Parcel No.] ZONING: ] RESIDENTIAL [ ] COMMERCIAL No. of Building # Persons Business Activity For Commercial Only ] Spas /Hot Tubs [ ] Floor /Equipment Drains ] Other (Specify) DATE: Page 1 of 3 SECTION 3 564 N E. 11Sfh STREET NORTH MIAMI. 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