85 NE 97 St (3)�` PERMIT APPLICATION FOR MIAMI SHORES VILLAGE �� /��
y
Notary as to Owner and/or Condo President
My Commission Expires:
FEES: PERMIT
RADON
Zoning Building
Mechanical Plumbing
Date 12. / g I Job Address £ A 47 Tax Folio ) I > �. o � �j ° / V
Legal Description ��, PP Historically Designated: Yes No
Owners / Tenant /WA ' Master r Permit #
Owner's Address 6 ,1 q7 CAL Phone FeI S - 75 - ? 2 3.
P
Contracting Co. //1/e. (✓s Address . / l y 2 d�' 2
Qualifier , e". ss# _ 3° '4.c1- 7IS 7
State # Municipal # Competency # Ins. Co.
Architect/Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING ME HANICAL OOFING PAVING FENCE SIGN
WORK DESCRIPTION a ..ef) c el4
Square Ft. Estimated Cost (value) L 0 0
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IIN 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.
OWNERS 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 do the work stated.
C.C.F. 0 NOTARY 0 O BOND 3 0 0
APPROVED: TOTAL DUES
S'_ a .e contractor or • . Buil� r
i
° otary as o Contrac
V _
My Commission Expites� �� : _ 1 ; " ; f �� a. W
Electrical
Structural Engineer
izi)xti °I
Date
STATE OF FLORIDA
111•, DEPARTMENT OF HEALTH L L
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONSTRUCTION PERMIT FOR:
[ ]New System [ ]Existing System [ ]Holding Tank
[ X ]Repair [ ]Abandonment [ ]Temporary
APPLICANT: Strong, Nathaniel AGENT: SR0931119, COCKING MSTEPHEN
PROPERTY STREET ADDRESS: 85 NE 97 St Miami FL 33138
LOT: 22 -23 BLOCK: 7 SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
PROPERTY ID #: 11- 3206 - 013 -1020 [OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC
DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME
PERIOD. 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. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM
COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL PERMITTING REQUIRED FOR PROPERTY DEVELOPMENT.
SYSTEM DESIGN AND SPECIFICATIONS
T [ 900 ]Gallon SEPTIC TANK MULTI - CHAMBERED /IN SERIES: [ Y ]
A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [ Y ]
N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY
K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS C [0 ]DOSES PER 24 HRS # PUMPS[ 0 ]
D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ 0 ]SQUARE FEET SYSTEM
A TYPE SYSTEM: [jf ]STANDARD [ N ]FILLED [ N ]MOUND [ N ]
I CONFIGURATION: [NN N ]TRENCH [ ]BED [ N ]
N a
F LOCATION TO BENCHMARK: Finished Floor of E /R, 13.30' NGVD.
I ELEVATION OF PROPOSED SYSTEM SITE [ 2.4 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 4.6 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT
L
D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 26.0 ] INCHES
OTHER REMARKS:
"DUE TO HIGH WATER CONSUMP9iON IT IS STRONGLY RECOMMENDED TO CHECK FOR A WATER LEAK, IF IT
IS NOT THE CASE INCREASE DRAINFIELD AREA."
This permit is not for addition (s)
*Existing 900 gl. septic tank.
*Install 300 sq.ft. of drainfield.
*Invert elevation to be no less than 9.23' NGVD.
*Bottom elevation to be no less than 8.73' NGVD.
IT ME SEPUo6 W1[S S(ii2 :2 PiT,PCP 11 D q SOLID
DEFLECTEI 9 DDEIJU6 OIL OUTLET TEF
SPECIFICATIONS BY: Icaza, Carlos
APPROVED BY: Icaza, Carlos
DATE ISSUED: 12/18/01
TITLE:
DH 4016, 03/97 (Obsoletes previous edition which may not be used)
(Stock Number: 5744- 001 - 4016 -0) Iostds_c,,s 4016 -11
pp 17 q - 3 .,S
tl�ta.�CU
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J 1 it `
rr �� r 5S 33 pp
fJ� �1n Cs �Y�l� f� Q .d �e, �:,'d lull b+a
TITLE: Engineer I
CENTRAX #: 13 -SG -11258
DATE PAID: I L-1,1 -O
FEB PAID : $ 5 c
RECEIPT .
OSTDSNBR : 01 -3829- -R
] Innovative» Other
Dade CHD
EXPIRATION DATE: 3/18/02
Page 1 of 2
LOT: n �`
PROPERTY ID 0: a D o v 255 4a 3 - 0 ,
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
PROPERTY SIZE CONFORMS TO SITE PLAN: [ ] YES [ ] NO NET USABLE AREA AVAILABLE: ®° cis
TOTAL ESTIMATED SEWAGE FLOW: % GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWAGE FLOW: EM/ ' GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: 440 SQFT UNOBSTRUCTED AREA REQUIRED: SQFT
BENCHMARK /REFERENCE POINT LOCATION: ✓� O / ° g f 8
rl
ELEVATION OF PROPOSED SYSTEM SITE IS °iJ [INCHES1±0 [ABOVE LO ) BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH
SURFACE WATER: PCg FT
WELLS: PUBLIC: 7Af /A FT
BUILDING FOUNDATIO S:
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [VINO 10 YEAR FLOODING? ( ] YES [ NO
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1 Jf & g
Munsell r Color Texture Depth
�3 �1A1
1n
USDA SOIL SERIES:
to
go=o9w cwrt o v-to
to
to
to
to
to
to
to
OBSERVED WATER TABLE: OF INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [9 NO MOTTLING: [ ] YES [t NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: CHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ N/] BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
STATE OF FLORIDA PERM %T t�
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
Al�/��4WD Cb-Og AGENT: A (1
BLOCK: SUBDIVIS ION: 4 0 » �" ' 1
(Section /Township /Range /Parcel No. or Tax ID Number]
CAN BE MAINTAINED FROM THE R
PROPOSED SYSTEM TO THE FOLLOWING FEATUS:
p
DITCHES / WALES: 4 0 0 FT NORMALLY WET? [ ] YES [ Y J NO
LIMITED USE: O FT PRIVATE: / FT NON POTABLE: °FT
FT PROPERTY LINES: 10 FT POTABLE WATER LINES: a FT
WRS -H Form 4015, Par 92 (Obsoletes previous editions which may not be used)
(Stock queer: 5744- 003-4015 -1)
FT MSL /NGVD SITE ELEVATION: /0 . q FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 2
DATE:
3MA
Munsell r Color Texture
I
illiannrOg
Depth
to
28 ° to 72
to
to
to
to
to
to
to
USDA SOIL SERIES: a.
Page 3 of 3
Scale: Each block represents 10 feet and 1 inch = 40 feet.
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6 .
Notes: ✓i �(1)N
Site Plan submi dhiX;,__
Plan Approv d
By
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number
o QF. Ce a&
D
if A
DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used)
(Stock Number: 5744-002 - 4015 -6)
PART II - SITEPLAN
r� R
srailr
Not Approved
LL CHANGES MUST i =}E APPROVED
E
V THE COUNTY HEALTH DEPARTMENT
4
c
s
Date Pp i
County Health Department
Page 2 of 4
MIAMI SHORES VILLAGE, FLORIDA
BUILDING ❑ ( -,. ,7 Date 19 4
ELECTRICAL ❑
PLUMBING ❑ PERMIT N? 8705 Contractor's
License No.
ROOFING ❑
❑ Work to be performed under this Permit
1/
'-- �c.c
Owner of /`
Building � ; iw �� , .: ; > ' - �� T / , , . p ,, l `
Architect
t,
Contractor
or Builder ����< �.. _ c
Legal Lox II
Description 11 Bl.
Address of ("-; q
Building �!
CONTRACTOR or BUILDER
Subdi-
vision
Sq. Ft.
Value of
Project
II Amount of
II Permit $
BY AUTHORITY
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 on drawings or in the statements or specifications and that he assumes respon-
sibility for work done by his agents se�vants or employees. \ . .
Signedj. -/ , (TNSPEC tR) BY
In consideration of the issuance to me of this permit I agree,ta 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 work done by either, mys f_my gent, s or employee.
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