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9437CONTR. LIST ... CLOSETS BATH TUBS SHOWERS Toms SINKS SLOP SINKS LAUNDRY TUBS URINALS CATCH BAs 1 N FLOOR DRAIN DRINKING FOUND NS TOTAL FIXTURES - CHECK . SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR HEATER ,---.--...— DEEP WELL SPRKLR. SYSTEM SW IM • 0 FOOL ,....■mimmi■ CONTR. LIST __ \ CHECK r.inn -----,--- Pt N0.fJ7 Date lin VP mbe.r..._..2.7. 1967 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, plan. ary ,(- ons must be kept at building during progress of work. pi - Owner's Name and Address ..12pe.a_Me Registered Architect and/or Engineer Employing Plumber's Name SIM GOT,T) SEPTIC TANK, INC,_NX.O.Box 7267-I Station Miami 55 Location and Legal Description Lot Block Subdivision Ave.&96th St Stateworktobeperformeilandpurposeofbuilding(ByFloors) 900 gallon septic tank w/360 sq. ft. drainfie Addition &Wks-- . — No. of Stories_ ..... Street and Nriluar E New Building Amount of Permit $ 7 .0-e? STATE OF FLORIDA, I ss. COUNTY OF DADE. Before me, the Ly t.Pg al IV' MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT Remodeling Size Septic Tr& Type of Tank Capacfty Feet of Drain Tile 3 sg. ft , flIst Feet of Tank or Drain Field from Well Nature of Water Supply: City—Well Size of Soakage Pit__ to me well /down, and who, being by me first &dy 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 d therein by him stated are true. Notary Pu"or fAC n 7,7 . . _ . 0 fc/06 Plumbing Inspector. The undersigned applicant for this building permit does hereby certify that he understands and a s his obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5968, 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 em ed 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 blic notice /or notices as are required by the Act. The undersigned agrees to employ only such sub-contractors, on won under t/ds permit, as are licensed by Miami Shores Village. administer oaths and take acknowledgments, personally appeared and that all faas Notary Public, State of Florida NOTE: A re-inspection fee of $1.00 will be made when such re-inspection is made by improper notice for inspection, or faulty materials and/or worlunanship. OF ,SAN IT , Ja (Address) Jn `accordance ;with the provisions of Chapter. 38`1 and> Chapter 387, Flo> ida Statues, „togpe Chapter.; XXI, Flori . s r n er n. t i . or r 1 ti drainage well . at Proposed Diameter . ro Weil ; Depth Proposed Casing depth { - Inspection ha been made of ` s ite of proposed drainage well by'a duly .authorized representative of th Sta te Bo ard of Health and permission! is'grarited for drilling the well with the provision t 1 ssued to: to op a • ta• a well.;ioccite Subleet,fo thefollt*fr g proviso iaccordance with fibs provisi r prove loon its c grhp�etion thI welly h e11 `l'h no cc�se`be' in service ,until the cattoched pe rrrbIt to oper ate has ;beers eomp isa )eted, signed by a du y a th rued representative of _the $fate Board o f Health, • and del ivered to :the Owrper I a` 'Phis permit revokable for failure to ce��' itl the provisions as stated herein. Grented this day. of , `19 Issued: by ' .. . This drainage welt is niche in diameter, feet deep, cased to a depth of set, drilled by CE�loes e �f ,Drr }ler) { Address of Driiler) Ttris pernnit is re e a t c o n y time for failure to corrtply with the-- priivisions stdtert heretrp;<dr if this i raunage we11 should. •at arty firms do cimrriate ar otherwise affect other wgters arc the: icinity, or for other. RLQ:iw Enclosures ' cc: Owner w /enc. cc: State Geologist w /enc. cc: SBH w /enc. DADE COUNTY DEPARTMENT OF PUBLIC HEALTH 1350 N. W. FOURTEENTH STREET MIAMI. FLORIDA 33125 Dear Mr. Well Drillers Your application for drainage well at the address shown on the attached fort . has been approved under the provisions stated on the form. Please notice that the form you are receiving is in two parts; the upper being the drilling permit and the lower one being a permit to operate drainage well. The provisions stated on the drilling permit are intended to guide you in drilling the well in accordance with the regulations of this office. The provisions stated on the operating permit inform the owner of the purpose for which the well is permitted, and of any special treatment which must be provided before waste can be discharged into the drainage well. After the well has been completed in accordance with the provisions of the drilling permit, you should fill in the blank spaces on the operating permit so that this form will show the actual diameter and depth of casing and the actual depth to which the well is drilled instead of the estimated diameter and depths as given on the upper half of the form. The completed orating permit form should then be detached and forwarded to the Dade County Depart- ment of Public Health so that it maybe countersigned and mailed to the owner. The drilling permit is for your files. Information copies of both the drill- ing and operating permits have been furnished to the owner, to the State Board- Of Health and the State Geologist, You are required to make a record of the log of the well one copy of which must be furnished to the State Geologist and the other copy to the Dade County Department of Public Health. The State Geologist may also require that you save cuttings from the well for his use, You are requested to notify this office of any change from the provisions of this permit prior to placing them into effect. Robert L. Quick, Director Engineering Division thine Prisblitmlaa T. E. Como. M. D.. M. P. H. DIRECTOR TELEPHONE 377-0341 BUILDING 0 ELECTRICAL 0 PLUMBING ROOFING 0 or Builder Legal Description 0 Address of Building CONTRACTOR or BUILDER MIAMI SHORES VILLAGE, FLORIDA Date Lot Bl• Work to be performed under this Permit This permit is granted to the contractor or builder named above to construct the building or to install the , equipment or device described in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. d; f t Signed • } ° ,_ (INSPECTOR) - BY In consideration of the issuance to me of this permit ? agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all walrk done by either, myself, my agent, servant or employee. } BY. Contractor's License No. Subdi- vision Sq. Ft. Value of 11 Amount of >' $ Project $ Permit AUTHORITY