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622 NE 97 St (9)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 APPLICATION FOR: [ ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental [ X] Repair [ ] Abandonment [ ] Other(Specify) APPLICANT: ANNA NENSTIEL AGENT: North Dade Septic Tank. MAILING ADDRESS: 800 N. W. 111th - ;Street, Miami, Fla 33168 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: PROPERTY ID #: PROPERTY SIZE: BLOCK: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: 1 2 3 4 SFR ACRES [Sqft/43560] PROPERTY WATER SUPPLY: ( ] PRIVATE [ ] PUBLIC SUBDIVISION: BUILDING INFORMATION [ ] RESIDENTIAL Unit Type of No. of No Establishment Bedrooms . E. 97 Street. Miami Shores, Fla 433138 - Building # Persons Area Sqft Served [ ] Garbage Grinders /Disposals f- Spas /Hot Tubs PERMIT 1 DATE PAID FEE PAID $ RECEIPT 1 TELEPHONE: 7 -6072 ] COMMERCIAL / DATE OF SUBDIVISION: [Section /Township /Range /Parcel No.] ZONING: Business Activity For Commercial Only [ ] Floor /Equipment Drains [ ] Ultra -low Volume Flus ets ( Other pecify) APPLICANT'S SIGNATURE: �.. / DATE: HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4015 -1) Page 1 of 3 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITE PLAN a/ daBa/ a//// /a / / / / / / / / / / / / //a / /aa /. /a/a / /// .e.... / /a ///O /t // as /1a/a /a/ / / /aa/a//// /a /a /// ///.0 ■ fa ffffff fiff■f■■f■ ■f■■ ■ /f■fa ■af ■ ■ff •/111111■■ /fff■ ■ f■f■a f■f■■ f■ as as ■ ■ffffafff ■aa■af■UUUa■f■•UU UU •• minon•a1111 w .11• XXIMIIIIIIIIMII 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l■ 11• Ih1c. H• f ■f ■faf01111ff•■.••■ ■f.•f ■0•••••• 1<aaaaaaaaaaafaaaaaaaaa minnWro ,oAzga/•all //i•La// /•WAWA• /aaaaaaaaaafaaaa/MINIM •aa /•••aaaa• Notes: ANNA NENSTIEL. 622 N. E.97th Street_ Miami Sherpa, Fla 3111'iR OLD SYSTEM Site Plan Submitted by: ATURE Plan Approved Not Approved Date By HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number 5744- 002 - 4015 -6) ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE County Public Unit Page 2 of 3 authorize the above -named r\ \ J A Notar to Owne PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date 6 -6 -94 Job Address 622 NE_ 97 ST 6 Legal Description Owner / Lessee / Tenant NP Owner's Address 697 NF _ 97 ST Contracting Co. North Dadc Sept.... Tank Address 800 NW 111 ST. Qualifier Dennis lVevllle SS# Phone 751 -7676 State # Municipal li Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PL[ING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION INSTALL @)) 200 sq.ft. draimfcild Square Ft. Estimated Cost(value) • $1uOu.uu WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT). Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. OWNER'S AFFIDAVIT: I certify that all the foregoing informatiq be done in compliance with all applicable laws regulating co contractor to do the work stated. P44 . Signature of owner and /or Condo'1'resident Date: r Condo President My Commisaffl M,TE OF FLORIDA AT LARD MY OOMM'fa BOURN LUNI 19, 1995 EONDEO TkRl1 HUCKLE3ERRY a ASSOCIATE ** * * * * * * FEES: PERMIT "4) RADON APPROVED: Zoning Mechanical Tax Folio Sig re of Contractor or Owner- Builder Date: r\ U'h. be Q .e 2 Not as to Co t a to or Owner- Builder My Commission E Tres: NOTARY PUBLIC; STATE OF FLORIDA AT LARGE - MY COMMISSION EXPIRES JUNE 19, 1995 * BODED THRUIUCKLEBE*RY & AS$DCIATES * * NOTARY TOTAL DUE 11 15 Master Permit # 3 & 3 a V Phone 759 -6072 at all work will ermore, I * * C.C.F. Fire Other Buildin Plumbin Electrical Engineering