TANK/DRAINFIELDtit
Date a I 9 Job Address 2 R 1 A . go S d 1 . Tax Folio
Legal Description 4/2)///i7 / Historically Designated: Yes ✓ No
Owner/Lessee / Tenant N� 6 'Eg Master Permit # 3 9o
Owner's Address 07 77 AI r •. 9Z1/1 //flo4($ £ ?G J Phone
Contracting Co. 49 - .S' 1: � r � ∎ - 1 Address /.fig ¢'-o e! e . / 3 M..0, ..a,,, • A lnl, t 1r t-
Qualifier - 7 7 G 'Fin/ - (a' e - , ,. SS# , Phone( x:} 1 4 5.' . 0ij'1,
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL LUMBING ECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION 6 e764. « Z.a. 1 , , ,, ,.d,{�+t/..e
Square Ft.
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 information is accurate and that all work will be done in compliance with all applicable
laws egulating construction and zoning. Furthermore, I authorize the above -named contractor to do the work stated.
Signature of owner and/or Condo sident Date
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
x//9/94
0.
0 /
■tary . s to Owner and/or Condo President Date
Commission Expires:
= JULIA S. FENTON
MY COMMISSION # CC 239506
EXPIRES: Novemt+er 1. 1996
;; ° Sanded ihnn Notary Pubic I ndmafteii
FEES PERMIT 35
• RADON
APPROVED:
Zoning Building •�
Mechanical Plumbing J
Estimated Cost (value) V, '
Signature of Contractor of i Owner= Bailder---
) 6 - 1- 11-7 i 9
Notary as to Contractor or Owner- Builder Date
My Commission Expires:
Electrical
a..
r
;2
Dat
C.C.F. a s NOTARY V TOTAL DUE
Engineering
4. Contractor's name and address*
feA ' v .ZA, e • - O.
5. Surety: (Payment bond required
Name and address.
Amount of bond* $
6. Lender's name and address
Notary Public
Print Nota
My Comm
12101 -112 7194 PAGE 3
IF (;r F' QR' A, COU`'T
It :" 'S'J Re•:.,: `.r..:.. i. t i.. spP" t93
t t, •'.'.: is :0
-e 62, , n. . to
.
•
�•'.'li ..at ,.Y! u, .- .4 is iY'tii't /�lf�f PCU:i�,.
PERMIT NO. TAX FOLIO NO. // .320 ,44/4
STATE OF FLORIDA
COUNTY OF DADE
T/= fit/EA/ Co el /:v
Be 69�.?t3 9' /h �'� �i
, PL. X33 .2 6 9
by owner from contractor, if any)
Signature of Owner /
Print Owner's Name ' Zfi n 0 � 9/1 e/Q)
Sworn to and subscribed before me this /5 day of ,199
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
/ > - 3.?e o /3y /lo
96R068320 1996 FEB 16 13:05
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance
with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal description of property and street address: .2 0 TS .24 is? 4 *.O 4.3 /4' f?2 o CAZ
o f r /1/ 1 v i S io +cS • 2 P7 .v. ,E. 94 r.
2. Description of improvement Tit/ S TA 1/ (0 i 2 14/A/ f lBoL. f /Os O/ 4/ PT
- TA A/ (coc,?) AV
3. Owner's), name and address T D A/ / 0 li E .rrr R - , P 7 U..E. 96
A / Ai 1
„c yo2 f /`l � . 3 /a/
Interest in property:
Name and address of fee simple titleholder.
- RR. C s sE i rle f-
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served
as provided by Section 713.13(1)(a)7., Florida Statutes.
Name and address:
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Uenor's Notice as pro-
vided in Section 713.13(1)(b), Florida Statutes.
Name and address.
9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless
a different date in specified)
Prepared by A/1/7e/t//0 d/44
Address 7 *In. n. 96 s7
//4/:0/P/'
14/ 2 /YI / S' S f/•
3 3/32
ti F/Z
LOT:
CON TRUCTION PERMIT F2:
[ New System [f1]
[7 ] Repair
APPLICANT:
PROPERTY STREET ADDRESS:
PROPERTY ID #:
SYSTEM DESIGN AND SPECIFICATIONS
T [!]o. ] ALLOW GPD
A [ ] [GALLONS / GPD]
N [ ] GALLONS GREASE
K [
SQUARE FEE
E FEET
SPECIFICATIONS BY:
D
[ ` ]
R [
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK:
L.
APPROVED BY:
DATE ISSUED:
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:
[ ] STANDARD
[ ] TRENCH
xisting System (� Hglding Tank
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
i
Abandonment Other(Specify)
4
.s#
q/, / e �. r ,6?. f `*" AGENT:
�- .,.. - .J Q
IMARY DRAINFIELD SYSTEM
SYSTEM
] FILLED
41
[
[
1'
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 -0)
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
APPLICANT
TITLE:
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.
ROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[
CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
[ ] MOUND [ ]
[
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 .FX,pi41 ION REQUIRED: [ ] INCHES
T �•1�'iL �,,.�„
E T
R 1�V'�. ,yl°i
CPHU
EXPIRATION DATE:
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBFR: Permit trucking number assigned by CPI-11.1.
APPLICATION FOR: Check type of permit, ;f "Other" specify type :n
APPLICANT: Property owner's Lill name.
TELEPHONE: Telephone minhr for applicant or agent.
AGENT: Property owner's legally authorized nvresenteitive.
MAILING ADDRESS: P.O. hr i strixt rnai1j address far applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY 1D#: 27 c , f orepecty. (C?FU rriy requite ienrocrty appraiser ID 11 or seetion/townshiphangdparcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum spec; Tieations from Chapter 10D-5, 'PAC.
DRAINFIELD: Miimum specitleations from Chapter FAC.
OTHER: alley spet:flied.i.ms, siieh ripe ati.ig permit ,- er.,niiemerits. low-vieume flush to:lei.s. variance iinovisos.
SFTCIFICATIONS BY: o f indivIcwal p r.'i spe, IF:cello:Ia. If feeeigned by a regi Acted. ergineer 7st be. sealed.
APPROVED BY: Pu1k Itudtir Unt r11Iu . ,2ersonriel neviewing urd approving permit.
DATE ISSUED: Dr.:et permit is CPHU.
EXPIRATION DATE: r dat. ;f the sy At.irn Rim for system repairs become void 90 days from the dte
,ded.
LOT:
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
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: D
AUTHORIZED SEWAGE FLOW: 577
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
SITE EVALUATED BY:
[]
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [4N0
Mun -ell Color Texture Depth
52,044 / b to /t
ma y■, .�
/2.% Leh
,5a.-�C 2 -' ' to „
to
to
to
to
to
to
USDA SOIL SERIES:
FT MSL /NGVD
`N
HRS-H Form 4015, Mar 92 (Obsoletes previous editions which - may not be used?
(Stock Number: 5744 - 003 - 4015 -1)
AGENT: fr CLC
PERMIT # 7t R ' � `
[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
e ' / 7,44/i,
[INCHES/FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURE p:
SURFACE WATER: //OL" FT DITCHES /SWALES: /Wee FT NORMALLY WET? [ ] YES [4 NO
WELLS: PUBLIC: NA FT LIMITED USE: "7' FT PRIVATE: ^/s! FT NON - POTABLE* /1,4. FT
BUILDING FOUNDATIONS: /0 FT PROPERTY LINES: /5 FT POTABLE WATER LINES: 2,Y FT
10 YEAR FLOODING? [ ] YES [...1 NO
SITE ELEVATION: FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 2
Munse.1 # /Color
C ,e.
Aegg
USDA SOIL SERIES:
Texture
,,ode
Depth
/ "to /2
Z to 2?"
P% " to,3G
to
to
to
to
to
to
OBSERVED WATER TABLE: ‘t✓ INCHES [ABOVE / j EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE //BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES ['( NO MOTTLING: [ ] YES [ XX J NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:/ DEPTH OF EXCAVATION: *5E' a INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [i/ BED [. ] OTHER (SPECIFY) '
REMARKS /ADDITIONAL CRITERIA:
DATE:
9‘
Page 3 of 3
Th S RJC ONS:
,.a
AGENT:
MAILING ADDRESS:
PROPERTY SIZE:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establi
11.
2
3
4
APPLICANT'S SIGNATURE:
STATE OF FLORIDA PERMIT # 6A 453
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID - -.) Syr
ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ � .&3
APPLICATION FOR CONSTRUCTION PERMIT RECEIPT #
Authority: Chapter 381, FS & Chapter 10D -6, FAC
APPLICATION FOR:
( ] New System [I4] Existing System [dA] Holding Tank WA]- Temporary /Experimental
DIAJ Repair [s Abandonment [M] Other(Specify)
APPLICANT: AA/ 72/1%0 A/464/C.X
"A. 2fv,s/
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: BLOCK: SUBDIVISION: DATE OF /91
SUBDIVISION:
PROPE1 Y ID #: [Section /Township /Range /Parcel No.] ZONING:
ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE (ii] PUBLIC
28? jE'. g6s1
[ RESIDENTIAL [ ] COMMERCIAL
3 goo
No. of Building # Persons Business Activity
Bedrooms Area Sgft Served For Commercial Only
TELEPHONE: 7.57-8/77
[m41 Garbage Grinders /Disposals U0. Spas /Hot Tubs W4] Floor /Equipment Drains
[All] Ultra -low Volume Flush Toilets [40 Other (Specify)
DATE: g/
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) Page 1 of 3
(Stock Number: 5744 - 001 - 4015 -1)
Scale: Each block represents 5 feet and 1 inch = 50 feet.
Site Plan submitted by:
D.O. j(af , //
Notes
Plan Approved
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTI / PERMIT
Permit Application Number ti-- O�
goo
7 1
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4015-6)
PART II - SITE PLAN
NAM
- I I , L ,1 1 ! _ r
IIrl I I II
[ : _ ! . 1 ,
4° 1- �II I, 11 � 1 1 J
I f III I I Il 1 l I I +1.-,-i 1 1 1 1 1' 4'
I I I I I I 111_'- 11 1 1 ' I
!* I _.
. . � 1G S
1 i 1
11_ I I I
123(196
SIGNATURE
I I.
I •
Not Approved
TITL
Date
County Public Unit
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
Page 2 of 3