121 NE 96 St (6)Permit No
-7 74 1
d -
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application 4 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. ,
Owners Name and Address 1, -&i-4 � r. No.0.0i / �g/ e.
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot.
Street and Number where work is to be performed —No Street.
State work to be performed and purpose of building (By Floors)
N Building ,__ —. Remodeling Addition
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
(Signed)
Date... - - — = ..l y_..�_...`��
Notary Public, State of Florida
Block Subdivision__..___.
Size Septic Tank_.-- __---- -- -- -- - -_— __._--_._Type of Tank__
Feet of Drain Tile___— _ Dist. Feet of Tank or Drain Field from Well. _...._ _ _...._...._
Nature of Water Supply: City—Well. Size of Soakage Pit.
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Worlanen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and Ilan 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 the 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.
Muter Plumber.
STATE OF FLORIDA, 1 µ
COUNTY OF DADE. 1
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
NOTE: A re- inspection fee of $1.00 will be made when such re.sspeotion Is mede.neoeasary by improper notice for inspection, or faulty
materials and /or workmanship.
CLOSETS
BATH
TUBS
SHOWER{
LAVA-
TORIES
SINKS
SLOP
SINK[
LAUNDRY
Tuns
URINAL/
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'N{
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
G
TRAP
SOLAR
NEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•O
POOL
copal'.
RV�•
.
LIST
�—
CHECK
Permit No
-7 74 1
d -
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other
structure herein described. This application 4 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. ,
Owners Name and Address 1, -&i-4 � r. No.0.0i / �g/ e.
Registered Architect and /or Engineer
Employing Plumber's Name
Location and Legal Description Lot.
Street and Number where work is to be performed —No Street.
State work to be performed and purpose of building (By Floors)
N Building ,__ —. Remodeling Addition
Amount of Permit $
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
(Signed)_
(Signed)
Date... - - — = ..l y_..�_...`��
Notary Public, State of Florida
Block Subdivision__..___.
Size Septic Tank_.-- __---- -- -- -- - -_— __._--_._Type of Tank__
Feet of Drain Tile___— _ Dist. Feet of Tank or Drain Field from Well. _...._ _ _...._...._
Nature of Water Supply: City—Well. Size of Soakage Pit.
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor
under the Florida Worlanen's Compensation Act, being Section 5988, Compiled General Laws of Florida Permanent Supplement, and Ilan 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 the 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.
Muter Plumber.
STATE OF FLORIDA, 1 µ
COUNTY OF DADE. 1
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared
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.
NOTE: A re- inspection fee of $1.00 will be made when such re.sspeotion Is mede.neoeasary by improper notice for inspection, or faulty
materials and /or workmanship.
N
Sign
Date 6/19/96 Job Address 121 NE 96 STREET Tax Folio //— 32...v6 — of
Legal Description tom/ .to E j7 /C / Q Historically Designated: Yes No
Owner/Lessee / Tenant JEANNE /ALBERT LAROCHE
Owner's Address 121 NE 96 STREET, MIAMI SHORES Phone 756 -1404
Contracting Co. LLYD— NORTH DADE SEPTIC TANK
Qualifier DENNIS NEVILLE
State # 025 -8368 Municipal #
Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): }AMAXKLMIGIKE PLUMBING 7eXki+E)XigaX#MXX4
WORK DESCRIPTION INSTALL DRAINFIELD
Square Ft. 400
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 regulatin• struction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOF
OWNER'S AFFIDAVIT: I certify that all the foregoing information is acc
laws regulating construction and zoning. Furthermore, I authorize the abov
APPROVED:
Zoning
Mechanical
f�iLt� e� ;/19/96
e of owner and/or Con o President Date
Owner an
My Commission Expir
FEES: PERMIT .3 ® RADON
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
esident Date
Y P Terc�a J. Felder
l ip � ...l! ,:� :�12 FFFOt_
> 4 OF - ;n ; .i:Licn Enpir:.a 0`I/1663 t a
) 1.800a 2TYICARY - Fla. Tc -y �; vice & Brnatt '
Building
Plumbing
6/19/96
C.C.F. /, 0
Master Permit #
Add 800 NW 111 STREET
SS# phone 751 -7676
Competency# 12842 Ins. Co RAVELERS /ESIF
Address
Address
Address
Estimated Cost (value) $1600.00
acto
xpir
to and th
amed con
Notary s to Con
ssion
actor or Owner-
be do
the work
NOTARY
CHANICAL WORK.
all work
actor to
s:
' `.
°A
1- coo -3 -1'D `2 71a.1rc ^& -
TOTAL DUE L34 .O co
Electrical
er- Builder
e in compliance with all applicable
tated.
uilder
6/19/96
Date
6/19/96
Date
Engineering
APPLICATION FOR:
] New System 11 ] Existing System
v[ ] Repair N( ] Abandonment
APPLICANT:
AGENT:
MAILING ADDRESS: f O ?;'',' 11! `3 RE i'. UTA :':( 33168
LOT:
PROPERTY ID #11 j
PROPERTY SIZE:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION ] RESIDENTIAL [ ] COMMERCIAL
Unit Type of
No Establishment
1
' 2
3
4
.1.-r
;
APPLICANT'S SIGNATURBi
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK: SUBDIVISION:
] Garbage Grinders /,.Disposals 1
] Ultra -low VolumeF1udh Toilets
Bedrooms Area Sgft Served
], Spas /Hot Tubs
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 #
] Holding Tank [,; ] Temporary /Experimental
] Other(Specify)
LAl OCFE TELEPHON117( , `i';i y
LLl Y} - NO1Til ii ,. 751-767
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]
DATE OF H
ti
SUBDIVISION:
[Section /Township /Range /Parcel No.] ZONING:
ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE yf ] PUBLIC
No. of Building # Persons Business Activity
For Commercial Only
0 ] Floor /Equipment Drains
] 'Other (Specify)
DATE(/ :i
Page 1 of 3
LOT:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
. ' ., con
%;p`
APPLICANT: LAW:CIE AGENT: NORTH BADE SEPTIC TANK
BLOCK: SUBDIVISION:
PROPERTY ID #: _/ , fl ' _ 2 S ko
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: [ ] YES [ ] NO NET USABLE AREA AVAILABLE: ,‘E: ACRES
TOTAL ESTIMATED SEWAGE FLOW: 206 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW: a 5 GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: (")(1 SQFT UNOBSTRUCTED AREA REQUIRED: L{- SQFT
BENCHMARK /REFERENCE POINT LOCATION: FFE C/,‘43 msl
ELEVATION OF PROPOSED SYSTEM SITE IS 12 (CS [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: 100+ FT DITCHES /SWALES: ---- FT NORMALLY WET? [ ] YES [Ri NO
WELLS: PUBLIC: 100 FT LIMITED USE: FT PRIVATE: --- FT NON- POTABLE: ---. FT
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 15 FT
SITi SUBJECT TO FREQUENT FLOODING: [ ] YES [X] NO 10 YEAR FLOODING? [ ] YES [ NO
10 YEAR FLOOD ELEVATION FOR SITE: W.T. 3.0 FT MSL /NGVD SITE ELEVATION: B_ ( FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color Texture Depth
BROWN SANDY I to 72"
USDA SOIL SERIES: s inY
to
to
to
to
to
to
to
OBSERVED WATER TABLE: INCHES imn / BELOW] EXISTING GRADE. TYPE: um / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: j (1 INCHES [mm BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [X] NO MOTTLING: [ ] YES [K] NO DEPTH: __ INCHES
SITE EVALUATED BY:\,_ \
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 1_91 DEPTH OF EXCAVATION: 33 INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH (Q(] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRIT
HRS-H Form 4015, Mar 92 (Obsoletes previous edit4ns which may not be used)
(Stock Number: 5744- 003 - 4015-1)
PERMIT #
[Section /Township /Range /Parcel No. or(Tax ID Number
SOIL PROFILE INFORMATION SITE 2
Munsell # /Color Texture Depth
USDA SOIL SERIES:
ANDY
to
— to
to
to
to
to
to
to
to
72"
DATE: 6f1R /96
Page 3 of 3
. . c • . •n.;
•
�. _ 07:7;:i".;
C:77. .. � . � r -� _ � � r� ,,. r .
7.
i.xorc. !
ON: „
r.
.... .. _. J� 7 . ... ..- ...i Xt_
O!.
CONSTRUCTION PERMIT FOR:
EN ] New System [ Ni Existing System ] Holding Tank [ ;T] Temporary /Experimental
[ Y 1 Repair [ Ise'] Abandonment [ \ ] Other(Specify)
APPLICANT: LPROCHE
PROPERTY STREET ADDRESS: 121 NE 96 STRF'T
LOT:
PROPERTY ID #: ` [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
4 2- ' 01 '; - ` 5 R D [ OR 1AX ID NUMBER
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -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 SPECIFICATIONS
'• XISTING
T [ 1050 ] [GALLONS / G] 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 PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
D [ 400 ] SQUARE
SYSTEM
[Rx] STANDARD [ ] FILLED [ ] MOUND [ ]
[ ] TRENCH [yam] BED [ ]
F LOCATION OF BENCHMARK: FFL:L T ' UST,
I ELEVATION OF PROPOSED SYSTEM SITE [ R',6�] [INCH
E BOTTOM OF DRAINFIELD TO BE [ T ]
0
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ ] INCHES
INSTALL 12" OF LOAMY COARSE SAND UNDER BOTTOM OF T1RAINFI) L'U
SUBMIT BENCHMARK BEFORE INSPECTION TH S PERMIT IS NOT FOR ADDTTTDNS .
MINIMUM INVERT ELEVATION:
MINIMUM BOTTOM OF DRAINFTFJ) ELEVATION: .{
R [ ] SQUARE
A TYPE SYSTEM:
I CONFIGURATION:
N
0
T
H
E
R
APPROVED BY:
STATE OF FLORIDA PERMIT #
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $
CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK: SUBDIVISION:
FEET MIAMIDRAINFIELD SYSTEM
FEET
SPECIFICATIONS BY: TITLE:
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
APPLICANT
AGENT LLLOYD NORTH DADS : SEPTIC
FT] [ABOVE/
FT] [ABOVE/
ih�L`o`Wy� BENCHMARK /RFERENCE_ POINTS
BENCHMARI7 REFERENCE POIN
TITLE•
r" c
DATE ISSUED: L d EXPIRATION DATE:
THE SEP1Ir TA NK SHALL BL PUMPED AND A SOLID
1 FEECTIO , DEVICE INSTALLED ON i THE OUTLET 1'� • r,.
CPHU
Page 1 of 2
INSIRUCrTeNS:
PERNtEl 11 Pmil tv4c king nmber assigned by CPUT.J.
A.I-PLICATION tr of pe...rnit, if speeify t'spc in bialt74.
PFLfCAT: ? css.n namu.
'.rel,Tfic rtn . .for appiicent ent.
1.ally alitSior:zeLl 1
A DIXR.ESS: P.O. jxr act .ria:!ing ad.d for appli.C<izli or. al.rent.
1. nr
f'r ;CI:FS0 . r.a2) . .. Tr 4 or , ...,,.:ct . o...,.to - J. , o..;! . .ip/re...,,ge/pare . .:! nnrfour)
DEIGN AND
SPEC.11- iC A.T1ONS:
'
\V nuni tcithm s foe ro 101:73-6.. i
frm Cb jkr 1CD-6,
such nporat:rig. p.eralit 'vat pro
Nara: rlesign.A zo.,7,inoer n.
Al'PROVEn Un't vst.vi end t
DNTEISSt:Fr: i by CPHU.
T,;\
EA :E: it: not bn iis.i. ';f7," CLyS frtl;E!
Notes
121 NE 9b 3TREE , _`I1.I FiTIORES 33138
(.ILLS l.:l : OVL l L�%till t'1G.
C:)StJ,k TI'UIN: NOT AV,ILABL
/ ,
r
Site Plan Submitted by. ' , _t
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART II - SITE PLAN
/ SIGNATURE TITLE
Plan Approved Not Approved Date
ALL CHANGES MU
HRS -H Form 4015. Feb 85 )Obso)etes previous editions which may not be used)
Stock Number 5744 -002- 4015 -6)
SEPTIC TANK TPI.M: 51 1 �C -
- APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
County Public Unit
Page 2 of 3