262 NE 97 St (6)Date 9/18/95 Job Address 262 NE 97 STREET Tax Folio
Legal Description
Owner/Lessee / Tenant POHOVEY Master Permit #
Owner's Address 262 NE 97 STREET, MIAMI SHORES 33138 Phone 756 -2508
Contracting Co NORTH DADE SEPTIC Address 800 NW 111 STREET, MIAMI
Qualifier DENNIS NEVILLE SS#
State# 025836 -8 Municipal# Competency# 12842 Ins. Co. TRAVELERS & ESIF
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION INSTALL DRAINFIELD
Square Ft. 200
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 a foregoing information is accurate and th ork will be done in compliance with all applicable
laws regulating cons ion and zoning. urthermore, I authorize the above -named , . n actor to do the work stated.
Signature of owner and/or Condo President
My
otary
A
to Owner
mmission Exp
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
FEES: PERMIT RADON
APPROVED:
Zoning Building
Mechanical Plumbing
9/1 8/95
President Date
, ter 'we Teresa J. Felder
at x ; e" Neely Public, State of Florida c
> ., `r, Coismission No. CC 480807
of FVF My Commission Esgiwss 07/16/59 .< ,
140).3- NOTAnY • Fit Notary Srn+scs & Rend n Co.
eeee(eeee eteeteeeteeeeeetee eeeeeeeeeeeeeteeeteee
Historically Designated: Yes No
Estimated Cost (value) $1000
Signat
tary as
tra or or er- Builder
o Contracto Owner Builder Date
ssion Exp
C.C.F. I NOTARY TOTAL DUE
Electrical
754 -3375
9/18/95
Date
9/18/95
tart MAtt ttttttattttittttttttsttttaitztta y,
,00 't/ Teresa J. Felder
1 a • ' Notary Public, State cf F edo
Comm :ssion No. CC 480107
'4 "br p.e My Co ntn fission Expires 07 /1&99
14100.344OTABY - Fa. Navy Savico & Boadin Co.
Engineering
LOT:
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK: SUBDIVISION:
AGENT: 11 ,, .....
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.
PROPERTY SIZE CONFORMS TO SITE PLAN: [, YES [ ] NO NET USABLE AREA AVAILABLE: ACRES
TOTAL ESTIMATED SEWAGE FLOW: ,;; GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW: � "'� GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
BENCHMARK /REFERENCE POINT LOCATION: ' � n
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 [;] NO
WELLS: PUBLIC:
BUILDING FOUNDATIONS:
SITE SUBJECT TO FREQUENT FLOODING: ,] YES [ I NO 10 YEAR FLOODING? [ ] YES [ ] NO
10 YEAR FLOOD ELEVATION FOR SITE: -' FT MSL /NGVD SITE ELEVATION: <�� - %' FT MSL /NGVD
Cl ` ai , r, o� o9,i_ ,
SOIL PROFILE INFORMATION SITE 2
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color Texture Depth
to Y2
USDA SOIL SERIES:
to
to
to
to
to
to
to
to
FT LIMITED USE: FT PRIVATE: FT NON - POTABLE: FT
FT PROPERTY LINES: FT POTABLE WATER LINES: FT
Munsell # /Color Texture Depth
to
to
to
to
to
to
to
to
to
USDA SOIL SERIES:
. r ,
OBSERVED WATER TABLE: INCHES [ / 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:
DRAINFIELD CONFIGURATION: [ ] TRENCH ['1 BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
DEPTH OF EXCAVATION: , INCHES
HRS -H Form 4015, Mar 92 (Obsoletes previous ei
ditons which may not be used)
(Stock Number: 5744 - 003 - 4015 -1)
DATE:
Page 3 of 3
CONSTRUCTION PERMIT FOR:
[''] New System [Al Existing System p'A Holding Tank E «7 Temporary /Experimental
[ ] Repair [V] Abandonment [7 ] Other(Specify)
APPLICANT: 7 AGENT "y �� -
0 U .�i l ', ` /'\; ' DSO ✓ - -v ,, , ,_, , % �
PROPERTY STREET ADDRESS: cm
of c
�C Vii% b ,/J ( G<
A// / l /
LOT: f f_'
PROPERTY ID #:
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.
T
A
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F
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SYSTEM DESIGN AND SPECIFICATIONS
[GALLONS / GPD] SEPTIC - -T NK /AEROBIC UNIT CAPACITY
[GALLONS / GPD] CAPACITY
SQUARE FEET PRIMARY DRAINFIELD SYSTEM
SQUARE FEET
TYPE SYSTEM:
CONFIGURATION:
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: ii i
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 10D -6, FAC
BLOCK: /� SUBDIVISION:
GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
N�] STANDARD
pAA TRENCH
LOCATION OF BENCHMARK: 7%" rT
ELEVATION OF PROPOSED SYSTEM SITE WA [INCHES /FT]
BOTTOM OF DRAINFIELD TO BE [ G %z2\ ] [INCHES /FT]
FILL REQUIRED: [ l �/ ] INCHES EXCAVATIoN "'R,EQUIRED:,_ [ ] INCHES
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM
[2 : ] FILLED
[3f] BED
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which raay.Mot be used)
(Stock Number: 5744 - 001 - 4016
TITLE:
TITLE:
=:r
[e MOUND [ ]
[]
[ABOVE /BELOW]
[ABOVE /BELOW]
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
e '?
MULTI- CHAMBERED /IN SERIES:[ ]
MULTI- CHAMBERED /IN SERIES:[
BENCHMARK /REFERENCE POINT
BENCHMARK /REFERENCE POINT
EXPIRATION DATE:
CPHU
age 1 of 2
Site Plan Submitted by
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
PART H - SITE PLAN
Notes:
I -a5 -H Fc-r 4015 -<`_ 85 ICbsdctes prev,cJs eciticrs rib:ch may rat be used)
:iJTt.' 5744-002-4015-0)
"'T.'8IG11ATbRE'
Not Approved
County Publ c
ALL CHANGES MUST RE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
TITLE
Date
Page 2 of