Loading...
526 NE 97 St (8)OW v' Date of Application /" /0-9 Z Name of Owner Type of Residential STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Mailing Address of Owner Staft N.I'r . Owner's Agent Agent's Mailing Address 211 j4 Type of Establishment I3 `'�. Tallahassee FL — 1904) 8 AUDIT CO(j.TROL NO. 302107 Applicant's Signature • c T L t 7 d HRS-H Form 4015, Feb 85 (Obsoletes previous editions which y not be used) (Stock Number: 5744-001-4015-1) Authority: Chapter 381, FS Chapter 10D-6, FAC Permit Application Number PART I — APPLICATION 1175339 (34,/y Telephone Number 7 T Y'' 3723 C{7 ST ' R -r4tf citiaP 8I uo Telephone No NO —ZZO O Property Street Address 2 N. C, ? - S t m + TOTAL FLOW = No. Bedrooms Heated or Cooled Area (each dwelling unit) (each dwelling unit) Builder S ot2eS • �./ Lot No Block No Subdivision Date Subdivided NOTE: IF NOT IN A SUBDIVISION ATTACH A METES AND BOUNDS DESCRIPTION This Application is for: New System Repair )( Sewage Flow (Gallons per day) 2, 4, 6 O ft2 Existing System No. Dwelling Units Sewage Flow Based On Sewage Flow . (Gallons per day) 7Sb Exact Directions to Property Page 1 of 3 ) APPLICATION FOR MUNICIPALITIES OF DADE COUNTY _ (OWNER TO RETAIN COPY) Job A d d r e s s ✓ o c, q 7 ' / ©l /7 /,3" 9 � s j Tax Folio /; Legal Descripti b0. j e, / 1 � /44 Master Permit # ,! e 9 :/ Owner / Lessee / Tenant i•ti L{: Cis y i4 rvi t4N" Owner's Address t4, La r S J phone Contracting Co. 4 I l4 _ A ►'�1 o is ; , Address 2/1") t n ) � � ,r� o r~1' -� f Y3 Qualifier !.,M iS) Wiffiri SSlfr �� phone ( "1. 146,V state it 6 PC 4%c Architect /Engineer Bonding Company Mortgagor Competency# Permit Type (circle one): BUILDING ELECTRICAL LUMBING'. MECHANICAL • -- WORK DESCRIPTION 1tiii L•2..f Square Ft. Estimated Cost ) c 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. 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 regulating construction and zoning. Furthermore, I authorize the above -named contractor to d6 the work stated. Signature of Owner and /or Condo President Date: NOTARY PUBLIC, STATE OF FLORIDA. MY COMMISSION EXPIRES: Sept. 29, 1995. BONDED TH TARY PUBLIC UNDERWRITERS. Ot ry as to Owner and /or Condo President M;r Commission Expires: r * * * * PERMIT FEE: t_s "be CO APPROVED: Zoning Mechanical Fire Building Plumbing Address Address Address Ins . Co . 614 Signature of Contra t • o Owne -bt►i? rie.r Date: ��� (dam Notary as to Contractor My Commission Expires: * * * * * Other Electrical ht 1 � ` �I ' "Eng� `�ineerun PAVING FENCE SIGN t y NOTARY PUBLI , S AT OF FLORI A. BONDED � TH R U 5 N0 NOTARY PUBLIC UN or Owner - Builder Scale: Each block represents 5 feet and 1 inch = 50 feet. Notes STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION AND INSTALLATION PERMIT Permit Application Number ( • e 1 1 71 _■ 1 1 1 1_ 1 • e‘ , 1 f -•.- , ;,!•:) PART II - SITE PLAN HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not b.) used) (Stock Number 5744-002-4015-6) • 1 • 1 , 0 : I '-'•,.. i:L , /•'• 4 •. ; • '''' 1 ,,. I I . 1 1 1 ■ 1 1 ! . 1 1 . 1 1 ' 1 '.1 1 1 0 I . 1 I ...' . I . . 0 • • i .1. r-i i I -,- ..._!-- i -, / - ! -t 0 t 1 • -: • . ? i- i , - 00 t__? , • ... • f0.00 • . ■ I. ,. I_ - --,-- - 1 . • , fi (( ('/) ;01 4- • ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT Site Plan submitted by: ?.y SIGNATURE TITLE • Plan Approved Not Approved Date By County Public Unit Page 2 of 3 Wage of Miami Shores N? 3601 1 JOB ADDRESS "--- N INSPECTION - 2 et. TIME READY \ ' r, ,, i : • /.),- e ,, REMARKS ,i- .,4'_: ,,, 7- INSPECTOR DATE