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760 NE 97 St (7)Installer 4 -4eL/2 -u Proper tank legend: Yes Tanks watertight: Yes Proper tank outlet device: Y Inspected by: Date 1 °/ ` '1 'Approved by: STATE OF FLORIDA DEPAFITMENT OF HEALTH AND REHABILITATIVE SERVICES PART III No HRS —H Form 4016, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744 - 002 - 4016.0) UCTION AND INSTALLATION PERMIT ONSITE SEWAGE DISPOSAL SYSTEM C Applicant 00/-e, 'lt/ v /U & 97 '— � 7 PART H - SYSTEM IPIS AL,LATION INSPECTION AND FINA INSTALLAT IO I APPROVAL- Permit Number Tank Manufacturer Tank material Tank level es No Tank size: gallons FINAL IN.ALLATION APPROVAL f s =74 gallons gallons Manhole or marker to gra• e: Yes No Drainfield Trench Absorption Bed Length Width ength Width Length feet x feet = ft feet fee . feet feet Length feet x — feet= ft feet •et feet feet Proper No. drainlines: Yes °� No feet feet feet Proper pipe separation: Yes No Total = ft Total = ft Distribution box level: Yes No Systems located as permitted: Yes ✓ No Systems including plumbing stub -outs installed at proper elevation: Yes No Average depth to drainpipe invert from finished grade: r d inches Maximum depth: Inches Average depth of drainfield gravel / inches Minimum depth of gravel AZ. inches Proper gravel size: Yes No Gravel is suitable quality: Yes No Backfill or fill material as required: (Quality) Yes 4-r No (Quantity) Yes L No Other findings: AN APPROVED I ►1 / r " ALLATIO I � D�E ' N e GUARANTEE PERFORMANCE 4 Date CO TY PUBLIC HEALTH UNIT Note: Completed copies of this for S. will be provided to the applicant, installer and the building department. Page 2 of 2 ...... CL ° /tTa BATH Tu // SNOWLR/ LAVA• TONICS SINK/ SLOP SINKS LAUNDRY TV // URINAL[ CATCH BASIN FLOOR DRAIN DRINKING FOVNT'N/ TOTAL P1ITVKL/ CONTR. LIST CHICK S[PTIC TANK SIWLR CONN. DRAIN Fill° BOAKAOL PIT GRIMM TRAP SOLAR N[ATLR Dace WILL 8 . 8 SViIM•G POOL CONTR. LILT _ �— CHICK Permit No " ikc ° 1 Owner's Name and Address Street and where work Number h k is to be performed No New Building My Commission Expires hAMI S} r+' RES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT ® 0)Q Size Septic Tangy _ _Type of Tank Feet of Drain Tile Dlnt. Feet of Tank or Drain Field from Well .. ._.__..__ Nature of Water Supply: City —WeIL Size of Soakage Pit (Signed) Date..._.. Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida. and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division mu of. Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications be kept at building during progress of work. 0 s. A) F Registered Architect and/or &.nninemK ` - e7 // 3 1 72 011 74 ' > erne Location and Legal piton Leif-4-1414 / dark Subdivision. 514- es. = �7 b 0 Street ..... . ! �!_.�_...7_6 — - State work to be performed and purpose of building (By Floors) __ . 5;'.k-A. D ts f Q! e !- V . J. _.. Remodeling —_ — _...__ Addition_. _ ......__ Repair No. of Stories Plumbing Inspec The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5986, Compiled General Laws of Florida Permanent Supplement, and IIaT mm- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors emplo ed by him in the wore- to he performed under this permit; and will post or cause to be posted' for inspection on the site of the work su - pubs c notice or notices as required by the Act. The undersigned agrees to employ only such sub - contractors, on to be licensed by Miami Shores Village. /r2--.2- " Notary Public, State of Florida this pengit, as PIP are Master Plumber. STATE OF FLORIDA, I COUNTn OF DADE. Before me, the undersigned authority. a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the. _.__.._ .._.._ -. -- - - ...._. of the above described construction, that be has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of 0.00 will be made whoa such rrispsedan >r snads by improper Dodo, far impaction, air faulty materials and/at wadaaanship• Permit No //767 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. al' Owner's Name and Address Registered Architect and /or Engineer_ _ Employing Plumber's Name ,1!____ r _ Location and Legal Description Lot Bloc Subdivision F- 1 ` r.... l Street and Number where work is to be performed— No.___% %_�:__7_____ „_1_______ ---- - Street State work to be performed and purpose of building (By Floors) New Building Remodeling __________ ,. ____ _____________ Addition__ _ Repairs No. of Stories Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well . Size of Soakage Pit Amount of Permit $ • ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the' provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, t COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) Date No Street My Commission Expires Notary Public, State of Florida Master Plumber. Street I - Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. CLOSETS BATH TUBS SHOWERS LAVA TORIES SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BASIN FLOOR DRAIN DRINKING" FOUNT' NS ! -.a • , t . '., - 7 ,1 ' -- TOTAL FIXTURES CONTR. LIST 1 ' g1 I - - CHECK ® °_ °� !T • �� SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER DEEP WELL SPRKLR. SYSTEM SW IM'G POOL CONTR. LIST � G' I I CHECK / Permit No //767 Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. al' Owner's Name and Address Registered Architect and /or Engineer_ _ Employing Plumber's Name ,1!____ r _ Location and Legal Description Lot Bloc Subdivision F- 1 ` r.... l Street and Number where work is to be performed— No.___% %_�:__7_____ „_1_______ ---- - Street State work to be performed and purpose of building (By Floors) New Building Remodeling __________ ,. ____ _____________ Addition__ _ Repairs No. of Stories Size Septic Tank Type of Tank Capacity Gals Feet of Drain Tile Dist. Feet of Tank or Drain Field from Well Nature of Water Supply: City —Well . Size of Soakage Pit Amount of Permit $ • ( Signed) Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the' provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub - contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. STATE OF FLORIDA, t COUNTY OF DADE. ss. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT (Signed) Date No Street My Commission Expires Notary Public, State of Florida Master Plumber. Street I - Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and /or workmanship. Permit No. New Building sk Employing Plumber's Name__ ..Zel -Q_ Location and Legal Description Lot .____.._ Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)___f. Amount of Permit $ ........... STATE OF FLORIDA, COUNTY OF DADE. Remodeling_ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. �,/ Owner's Name and Address ____� ._____�___._.___ No._�__ _ `° ®__________ Street N 7--r� - " Registered Architect and /or ______ No./ a L Street__ Addition Block _.___---- _ -__ -. Subdivision -------------------......... ----__--- Street Repairs No. of Stories. _ Size Septic Tank_ _--------- _- __- .- __--- _----- _ - -_ -- Type of Tank Feet of Drain Tile_ D isst.. Feet of Tank or Drain Field from Well G Nature of Water Supply: City —Well. ,‘ -1 !L!C _ a Size of Soakage Pit Capacity Gals (Signed)- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) __ - Date Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made• necessary by improper notice for inspection, or faulty materials and/or workmanship. CLOSETS BATH TUBS • SHOWERS LAVA. TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BAB'N FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT . GREASE TRAP SOLAR H EATER DEEP .WELL SPRKLR. , SWIM'G POOL CONTR. LIBT CHECK t/ ®� / 1/2) -- Permit No. New Building sk Employing Plumber's Name__ ..Zel -Q_ Location and Legal Description Lot .____.._ Street and Number where work is to be performed —No State work to be performed and purpose of building (By Floors)___f. Amount of Permit $ ........... STATE OF FLORIDA, COUNTY OF DADE. Remodeling_ MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. �,/ Owner's Name and Address ____� ._____�___._.___ No._�__ _ `° ®__________ Street N 7--r� - " Registered Architect and /or ______ No./ a L Street__ Addition Block _.___---- _ -__ -. Subdivision -------------------......... ----__--- Street Repairs No. of Stories. _ Size Septic Tank_ _--------- _- __- .- __--- _----- _ - -_ -- Type of Tank Feet of Drain Tile_ D isst.. Feet of Tank or Drain Field from Well G Nature of Water Supply: City —Well. ,‘ -1 !L!C _ a Size of Soakage Pit Capacity Gals (Signed)- Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the work such public notice or notices as are required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are licensed by Miami Shores Village. (Signed) __ - Date Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made• necessary by improper notice for inspection, or faulty materials and/or workmanship.