37 NE 97 St (4)Date L i i / q /-3 Job Addressg7 Air 9' 7 f J Tax Folio // 2 O6 �2 007
Gm7r ,3 &/ , 4/L,i 2e /
Legal Description �,�
Owner / Lessee / Tenant SIV ‘ Master Permit # 3iyU -�°
Owner's Address ..".? /l.f 9 S / Phone
Address P:33,5 /jw 1- J
Qualifier LO., gu-oide sS# /3S - - W Phone 574 11 BO
State # / Municipal # o27/ `OP Competency # 93-1D Ins .Co &/V / iU
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type(circle one): BUILDING ELECTRICAL ,P MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION
Contracting Co. &OM 7061
Square Ft. O Q Estimated Cost(value) / add
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 informati is accurate and that all work will
be done in compliance with all applicable laws regulating c ruction and zoning. Furthermore, I
authorize the abo -named contractor to do the work stated.
Signature of owner and /:r " ondo esident
D
Notary as Owner and /or Condo President
My Commission Expires: )1.5-93 -40' ( I
DWAYNE d.*4 7
State of Flori
PP BC1`N13E15 11
PIEIRMIIT AJPP LIICATIION FOR MIIAMII SNORES VIILLAGE
DitAvu
Notary as Contractor
ssion Ex ires:
AYNE D. HA
State of Florida
My Comm. Exp. 11gRe
BONChED
or Owner - Builder
tl -S�'3
* tr a
FEES: PERMIT , VAD RADON C.C.F. NOTARY TOTAL DUE O
APPROVED: Fire Other
Zoning Building Electrical
/
Mechanical Plumbin 4- ' 4 '� T r = ineering
CONSTRUCTION PERMIT FOR:
[ ] New System [ ] Existing System [ ] Holding Tank [ ) Temporary /Experimental
] Repair [ ] Abandonment [ ] Other(Specify)
v'"'' ' V 8 A AGENT: 61-7c,014.0 4?
3 - 7 ' 5 S',1
APPLICANT:
PROPERTY STREET ADDRESS:
LOT:
PROPERTY ID #:
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: .
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
T [ ] [GALLONS / GPD] 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 [ 3 `° -0 J SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [/ j STANDARD [ ] FILLED
I CONFIGURATION: [ ] TRENCH [ a] BED
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
CPHU -White
i
] INCHES
-1, 9`3
Applicant- Canary
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER)
TITLE:
TITLE:
HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016-0)
PERMIT # - • / a2
DATE PAID
FEE PAID $
RECEIPT #
[ ] MOUND [ ]
[ ]
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
EXPIRATION DATE: 7G , .
Page 1 of 2
Installer /Contractor -Pink Building Department - Goldenrod
INSTRUCTIONS: •
PERMIT NUMBER: Permit tracking number assigned by CPHU.
APPLICATION FOR: Check type of permit, if "Other" specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID#: 27 character id number for property. (CPHU may require property appraiser ID N or section /township /range /parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 10D -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D-6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CPHU.
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date
issued.
I
Notes*
1
I '
i• 1
, I
1 1 I • ;
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1
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Site Plan Submitted 41 "'
Plan Approved
By
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-002-4015-6)
!LIT r_u.„,„
, •
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,t1I'ii111 I'
U ' I ! I I 1 !
ST TE OF FLORIDA
DEPAr 1 MENT OF HEALTH AND REHAEzILITATIVE SERVICES , ...
-._.: if.' ';')
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT'
, ,v 2, / i P ' ,_.
). •
/ r' . 4. i . 7 Permit Applicati:oh.fclUmb ., :•,' , - ,2
PA H SI E PLAN ___..6•+...
,-
SIGNATURE
I _
111_11
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Not Approved
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ALL CHANGES MUST BE APPROVED BY TH COUNTY PUBLIC HEALTH UNIT
TITLE
Date
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• ...sir
4- -
County Public Unit
Page 2 of 3
APPLICANT:
LOT:
PROPERTY XD 1/:
BLOCK:
STATE OF FLORIDA
DEPARTMENT OF HEALTs'. AND REHABILIT TIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTE?1 SPECIFICATIONS,
%Pim CV FR&
SUBDIVISION:
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH P %,GE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN:
TOTAL ESTIMATED SEWAGE FLOW: 4/S03
AUTHORIZED SEWAGE FLOW: --r--
UNOBSTRUCTED AREA AVAILABLE: /242
YES [ ] NO NET US -.LE AREA AVAI I r =•LEE ACRES
GALLONS PER DAY [RESIDENCES- T %,' -LE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /%,CRE]
SIFT UNOBSTRUCTED AREA REQUIRED: SQFT
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS / [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK ICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: FT DITCHES/ WALES: , 4)/'9 FT N fftMALLY WET? [ ] YES G O
WELLS: PUBLIC: FT LIMITED USE: .FT PRIVATE: /FT NON- POTABLE: Gy FT
BUILDING FOUNDATIONS: > FT PROPERTY LINES > )_ FT POTABLE WATER LINES ? ?f FT
SITE SUBJECT TO FREQUENT FLOODING:
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color Texture Depth
to
to
istA) EHEE to
to �
to
to
to
to
J,
USpA SOLI ,-SERIEr
SITE EVALUATED BY:
OBSERVED WATER TABLE: /' INCHES [ABOVF�� BEL0 ] EXISTING GRADE. TYPE: [PERCHED -/ �,REY ].
EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [4 NO MOTTLING: [ ] YES ( 4?0 DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: /b/--/
DEPTH OF EXCAVATION: 2 F INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
..:,
ESTIMATED WET SEASON 6/ATER TABLE ELEVATION* jf INCHES [ ABOVE /
[ ] YES [O 10 YEAR FLOODING? [ ] YES [
FT NSL /NG D ?, iiTE ELEVATION: FT MSL /NGVD
AGENT: ,e CO/:! h 06 7 L3e
[ Section /Township /Range /Parcel No . or Tax ID Number]
SOIL PROFILE INFORMATION SITE 2
DATE:
Munsell # /Color Texture
USDA SOIL SERIES:
Depth
to
to
to
to
to
to
to
to
to
HRS -H Form 4015, {far 92 (Obsoletes previous editions which may not be Used)'' Page 3 of 3
(Stock Humber: 5744- 003 - 4015 -1)
APPLICATION FOR:
[ ] ew System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
[ Repair [ ] Abandonment [ ] Other(Specify)
APPLICANT: S / A / ,pe
AGENT: CO'd 0 04%W_
MAILING ADDRESS: � /9 cc
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH '= •UILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 1OD -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTAC! LEGAL DESCRIPTION OR DEED]
LOT:
PROPERTY ID 0:
STATE OF FLORIDA PERMIT 0
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE P ID
ONSITE SEWAGE DISPOSAL SYSTEM FEE P %r ID $
APPLICATION FOR CONSTRUCTION PERMIT RECEIPT 0
Authority: Chapter 381, FS II Chapter 1OD -6, FAC
BLOCK: SUBDIVISION: DATE OF
SUBDIVISION.
[Section /Township /Range /Parcel No.] ZONING:
PROPERTY SIZE: i ACRES [Sqft/43560] PROPERTY WATE SUPPLY: [ ] PRIVATE [i%] PUBLIC
PROPERTY STREET ADDRESS: 32 /u 5'1 -2 S r 3; (7
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
3
4
[ ] Garbage Grinders /Dispos s
[ ] Ultra -low Volume Flushilets
APPLICANT'S SIGNATURE
[ r1RESIDENTIAL [ ] COMMERCIAL
No Establishment Bedrooms Area Sqft Served
Spdc„,(63--72-70 7 3 ism
a
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Humber: 5744- 001- 4015-1)
TELEP. ONE: 7 5- -,+ VW/
Unit Type of No. of Building 0 Persons Business Activity
DATE: `5
For Commercial Only
[ ] Spas /Hot Tubs [ ] Floor /Equipment Drains
[ ] Other (Specify)
Page 1 of 3
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