857 NE 97 St (2)... •
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Page 2
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PERMIT APPLICATION
IMPORTANT NO Ic.a
1. DO NOToBEGIN ANY W'ORIe MTHOU'1"HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant
the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m.
to 5:00 p.m. No inspections will be conducted on weekends or holidays.
2. All construetlgp of actm 3r'eas I3U :T tltMAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris.
3. STREETS AND NI!1VHBVItII:IG3 Rji1RTfS SHALL BE KEPT FREE FROM DIRT AND DEBRIS.
4. SWALES Mu §T ar Rp1 3 C'I t1 Q2QM'BAING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is
required for work in or near the street/sidewalk.
5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer
which requires a separate permit.
6. PORTABLE TOILETS for a construction site require a separate permit.
7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department
8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement.
9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources
Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers.
AFFIDAVIT - Please read carefully.
Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, 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, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY,
ROOFING and SIGNS and there may be additional permits required from other governmental agencies.
I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve
months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and
any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the
present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business
under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must
conform to the current code requirements of the Building Code.
WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for
improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with
your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at:
22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in
accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and
Choosing a Contractor.
STATE OF FL ORI , COUNTY OF MIAMI -DADE
Signature of Owner
CcY1C lc(
Pnnt Name
Sworn to and subscribed before me this 1 9_ day of ,
Signature .l Notary Pub ' State of Florida
O tt v� Angela M Becker
.9 Q My Commission DD150048
Nr-0,,,r, Expires November 15, 2006
SEAL:
STATE OF FL
COUNTY OF MIAMI -DADE
Signature of Contractor / Qualifier
Print Name
Swo to and subscribed before me this ) 3 day of
14.4.
Signature o'/ o ry Public Sta '- . ' orida
SEAL:
eviN Angela M Becke
My Comm's. L
4 ti
��d� Expi Nove: ,
Personally known OR, Produced Identification Personally know n OR Produced
Identification
Type of Identification Produced: iL b ,25 t / ` fie_ a \/3_ bype of Identification Produced:
CONTRACTO;"
Name / l m OK 4itall
Name 's�� . q ce $
I /ay64
License No. S 6 / 07. Q J
•
Address / f9 15 z A / 2
Repair
Telephone e5 Fax
Alteration Interior
Qualifier Name
Demolish
PROPEi "TY OWNER
Name / l m OK 4itall
Address 8 . /v E. ?7 S116.' -/ P
Home Telephone T „ 7,5.7 7L
Business Telephone
Fax
TYPE OF MANAGEMENT (✓ )
New Construction
Enclosure
Alteration Exterior
Repair
Alteration Interior
Demolish
Relocation of Structure
Shell Only
Foundation Only
Add'I Attachment
Other
Add'l Detachment
Other
Step 1.
Job Address:
PERMIT TYPE (✓ )
Building
Electrical
Mechanical
Plumbing
LPGX
Roofing
Fence
Other
2 5 e Al4k4
Folio Number
Lot Block
Subdivision PB PG
Current Use of Property
Proposed Use of Property
Tenant Information
PERMIT CHANGE (✓ )
Chg. Contractor
Renewal
Revision
Extension
Supplement
Reinspection
ARCHITECT .
Name
License No.
Address
Telephone
Fax
Description of Work
Zoning
Square Feet
• • ... •
•
•
Master Permit No. • . •
Subsidiary Permit No:
•••
INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village:
•
Complete the attached permit application which must be signed by the property owner and quIllie •Httlt :nauces vest beaotarized. Please
print or type to allow for a more accurate processing of your application. If roofing work will (be Toile, a roof ratio : Lust be submit- •
ted along with this permit application.
Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the
processing of your application, you may be asked to submit additional information.
A PPLICATION
Address Apt. City State
, 1�6e. .)
Linear Feet
Units
•
0
• • ...
• • • • • • •
• • • • • •
• • ° F RNIIT APPLICATION
1 . •
• • • • •
• • • . •
37/34
Zip
Floors
Value of Work`s 7 2. 1) O Bldg Value
Tax Assessed/Appraised Value
Flood Zone Base Floor Elev.
ENGINEER
Name
License No.
Address
Telephone
Fax
ELECTRICAL
TYPE
Minimum Fee
QTY.
TyI'E
Dryer
QTY.
TYPE
Outlet, Appliance • •
91 Y.
I •
'1' VP.:
Serum Repair. •
QTY.
A/C Central 1 -3 Ton
Fan
Outlet, Wall
Service, Temporary
A/C Central 4 -7 Ton
Fire Pump
Outlet, Switch
Signs
A/C Central 8 -15 Ton
Fixture - Fluorescent
Oven
Space Heater (kw)
A/C Central 16-20 Ton
Fixture Light
Parking Lot Lights
Spas/Hot Tubs
A/C Central 20+ Ton
Flood Lights
Plugmold/Strip
Subfeeds, No. of Amps
A/C Window
FPL - Load Central
Posts
Swim Pool, Commercial
Air Conditioners
Garbage Disposal
Range/Range Top
Swim Pool, Residential
Chiller
Generators, etc.
Receptacles
Switchboards
Clear Violations
Heat Recovery
Refrigerator, Comm. (p/PH)
Temp Serv., Construction
Compactor
Low -volt, Burglar
Refrigerator, Domestic
1
Temp for Test - 30 days
Deep Freezer
Low -volt, Fire
Renew - Temp Service
Water Closet
Demolition
Low -volt, Intercom/Teleph.
Repair Circuits
Water Heater
Dishwasher
Low -volt, Television
Service, Number of Amps
Water Heater New
MECHANICAL
TYPE
Minimum Fee
QTY.
TYPE
Condensate Drain
()Ty.
TYPE
Generator
QTY.
1V'1'E
Refrigeration, Tons
QTV.
A/C Central, Tons
Cooling Tower
Heating Strips, each
Vent Hood, Cost
A/C Wall/Win. Tons
Dryer Vents, Number of
Paint Booth
Ventilation, Cost
Air Handler, Tons
Ductwork, Cost of
Piping, Flammable Liquid
Periodic Inspections
Barbecue
Fire Sprinkler System
Process/Pressure Piping
Supply, AC Well
Bath Fan - Vented, #
Fireplaces, Number of
Pressure Vessel
Temporary Toilet
PLUMBING
TYPE
A/C Condensate
QTY.
TYPE
Drains, Roof
QTY.
TYPE
Miscellaneous Fixture
QTY.
TYPE
Soakage Pit
QTY.
Bath Tub
Drinking Fountain
Miscellaneous Repairs
Solar Water Heater
Bidet
Filter Replace
Pool Piping
Sprinkler Repair
Cap - Fixture
Fountain
Pump and Abandon
Sprinkler System
Cap - Water
Gas - Appliance
Pump, Domestic
Supply, AC Well
Cap - Sewer
Gas - Natural
Pump, Fire Stand
Temporary Toilet
Catch Basin
Gas - Propane
Pump, Re- circulate
Temporary Water Closet
Clothes Washer
Gas Piping
Pump, Replace - Pool
Urinal
Dental Chair
Grease Trap
Pump, Sprinkler
Utility - Sewer
Discharge Well
Ice Maker
Pump, Sump
Utility - Water
Dishwasher
Indirect Wastes
Relay Repair
1
Vacuum Pump
Disposal
Interceptor
Roof Inlet
Water Closet
Domestic Well
Laundry Tray
Septic Connection
Water Heater
Drainfield, 4" Tile/Res.
Lavatory
Septic Tank
Water Heater New
Drains, Area
Meter Set (Gas)
Sewer Connection
Water Re -pipe
Drains, Floor
Minimum Fee
Shower
Water Service
Drains, French
Miscellaneous Equipment
Sink
Well, Supply
Page 3
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• • • • • • •
" 'PERMIT APPLICATION
• . •.. • .•
•. • • •• •
• • • • • • • •
INSTRUCTIONS: Please indicate the type of work being performed and quantity(iU.in tl 4pi pro;iied•Olow.
RECEIVED AND REVIEWED BY: DATE:
• •
Page 4
Notary
(Attach
• •
• 0
0 00 0
• • • •
OFFICZ USE OW.Y •
• • • •
•
CONCURRENCY
(New Construction)
• • • •
• ••• • •
O 0 0 0 •
o 0 0 0 •
•
▪ • •
• • • •
CHEC1.
0 OWNER - BUILDER FORM
•
0
0
••• o• o o • ••
• • • • • • • • 0
• •• • • o • ••• •
ll FIRE DJ PARTt EN'f. o ® o : •
•• ••• • • 0 0 • 00
APPROVAL (Commercial /
multi - family)
® OTHER
(Specify & Attach)
$3.00 per page (Scanning Fee)
Miami Shores Village
Bond
Metropolitan Dade County (C.C.F.)
Inspector State Educational Fund
State DCA (Radon)
Code Enforcement Fine
Zoning Review
•
DI PROOF OF OWNERSHIP
(Attach)
HRS / DERM APPROVAL
(Septic / Sewer)
CI IMPACT FEE
(New Construction)
m OTHER
(Specify & Attach)
$ O )
$'3 00
$
(sq.ft. = x/1000
$ (¢.005 /sq.ft.)
$ (0.01 /sq.ft.)
$ - u c�
SECTION
Zoning
Electrical
Mechanical
Plumbing
Fire
Public Works
Structural
Building Official
BY
DATE
ffi
PERMIT APPLICATION
CI CONDO ASSOCIATION APPROVAL
(Attach)
• BPR APPROVAL (Restaurants)
CO CONTRACTOR REGISTRATION
(On File)
PERMIT FEES
TOTAL $ -j •
ISSUING OFFICIAL
REVIEWED AND PREPARED BY: DATE:
CONDITION OFAPPROVAL
Revised July 2001
10050 N.E. 2ND AVE., MIAMI SHORES, FL ° (305) 795 -2207 ° FAX (305) 756 -8972 o http : / /www.miamishoresvillage.com
PAY
TO THE
ORDER OF
FOR
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 2/13 /2003
Applicant: MARK
Owner: ORLANDI
JOB ADDRESS: 857 NE 97
(J Contractor MR C'S SEPTIC TANK
Po Local Phone: 305 - 651 -7859
t Parcel # 1132060142620
C
Fees:
FEE2003 -979
FEE2003 -980
FEE2003 -981
FEE2003 -982
Description
Building Fee
Buildier's Bond
CCF
Notary Fee
Total Fees:
Amount
$80.00
$300.00
$1.20
$5.00
$386.20
Total Fees: $386.20
Total Receipts: $0.00
Approved
Permit Status:
Permit Expiration:
p Work: TO REPLACE DRAINFIELD
If there is nn nas.. - ; 4
MR. C'S DRAIN, INC.
TING PD.
MIAMI, 68 FL 3 7859
33 69 -0239
0.19
4 ,:
Plumbing Permit
Permit Number: PL2003 -49
Legal Description: MIAMI SHORES SEC 3 PB 10 -37 E1/2 OF LOT 19 & LOT 20
8/12/2003
ORLANDI
MARK
ST
Construction Value:
Contractor's Address: P 0 BOX 693239
DATE
/3
Washington Mutual
nnggtWonn FA
Mlamy199M street FFlnancial Center 1711- Tae -70o0
175 NW. 199th street , 44 how Customer Service Mieml, FL 33169
,e4 : E.'7
i
u' 00i 000638 ?u■ ;i :267084 L3 L : 3830308'. 20e
$2,200.00
•
DOLLARS 8
6387
63- 8413/2670
Soc.. Foldurai
Re- inspection
BLK 73
cation herefor in strict compliance with all
fications that may have been submitted to
or if the plans are changed without
)onsibility for a thorough knowledge of the
:hat he assumes responsibility for work done
is pertaining thereto and in strict conformity
)sponisibility for all work done by either
•('
.04
'HARK ANDREW ORLANDI
400 NE 102 ST
c .„ MIAMI SHORES, FL 33138-0000 tSLi
07-03-65 5
08-22,71991
0645-541-65-243-0Aro 07:-0-1998
CLASS: E
DATE 2
1
SAFE DRIVER
o
I
FLORIDA 8=
—The Sunshine State
CONSTRUCTION PERMIT
[ ]New System [
[ X ]Repair
APPLICANT: Orlandi, Mark
LOT: 19 BLOCK: 73
PROPERTY ID #: 11- 3206 -014 -2620
SYSTEM DESIGN AND SPECIFICATIONS
T [
A [
N [
K
D [
R [
A
I
N
F
I
E
L
D
STATE OF FLORIDA
DEPARTMENT OF HEATTH
ONSITE SEWAGk; TR.yTMENT AND L . POSAL SYSTEM
CONSTRUCTION PERilrir
FOR:
]Existing System
]Abandonment
1V
]Holding Tank [
]Temporary
AGENT: SR0931119,
PROPERTY STREET ADDRESS: 857 NE 97 St Miami FL 33138
SUBDIVISION: Miami Shores
[Section /Township /Range /Parcel No.]
[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.
900 ] Gallons SEPTIC TANK
0 ]Gallons
0 ]GALLONS GREASE INTERCEPTOR CAPACITY
0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS
LOCATION TO BENCHMARK: Top of Bottom
ELEVATION OF PROPOSED SYSTEM SITE [
BOTTOM OF DRAINFIELD TO BE
FILL REQUIRED: [ 0.0 ]INCHES
OTHER REMARKS:
This permit is not for addition(s).
*Existing 900 gl. septic tank to remain.
*Install 300 sq.ft. of drainfield./
*Invert elevation to be no less than 7.83' NGVD.
*Bottom elevation to be no less than 7.33' NGVD.
T' C PTIC TSa°?N SHALL QE P'siiZ;':cf1 A9'D A SOLID
DEFLECTION DEVICE INSTALLED ON T }3E OJTLLT TEE
SPECIFICATIONS BY: Icaza, Carlos
APPROVED BY: Icaza, Carlos
DATE ISSUED: 2/13/03
Fl or, 11.80' NGVD.
.3 ] [ FEET ]
4.5 ] ( FEET ]
EXCAVATION REQUIRED: [ 26
TITLE:
DH 4016, 03/97 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001 - 4016 -0) (ostds_cons_4016 - 11
TITLE: Engineer I
• Ca/'M #6 13.- $G;15565
• DATE JA:D :'. :
• FEB• PA • s
RECEIPT' ' "'
OSTDSNBR :
• • •••
• • •• •
• • • •
• • •
• • • •
••• ••• •
] Innovativ
N4. ]• • • • • •
• • •
COCKING SIS'.f$P4Erl•
MULTI- CHAMBERED /IN SERIES: [Y ]
MULTI- CHAMBERED /IN SERIES: [Y ]
•• • • • • •
Q [0 ]DOSES PER 24 HRS # PUMPS[ 0 )
300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM
0 ]SQUARE FEET SYSTEM
TYPE SYSTEM: [ . ' ]STANDARD [ N ]FILLED [ N ] MOUND [ N ]
CONFIGURATION: [ N ]TRENCH [`� ] BED [ N ]
(
(
BELOW ] BENCHMARK/REFERENCE POINT
BELOW ] BENCHMARK/REFERENCE POINT
.0 ] INCHES
03 -0481- -R
• •••
• • •
• • •
• • • •
e Other
�•- ••
• •
• •
• •
•
••• ••"
THIS PERMIT IS NOT FOR ^ cDii o,iN(S
INV ET_: NA"iiO=''7BN J
BOTTOM OF DR AariT'E"LD ET E A ION 7- • 3
Dade CHD
EXPIRATION DATE: 5/14/03
Page 1 of 2
APPLICANT:
LOT: /,
PROPERTY ID #:
STATE OF FLORIDA,
DEPARTMENT OF HE',iH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
. /
/s. r4/if
BLOCK:
! ,r�li 1
SUBDIVISION:
cf,' D /L/ -7!
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUS:
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: O- /92- ACRE
TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2
AUTHORIZED SEWAGE FLOW: t 'O GALLONS PER DAY [1500 GPD /ACRE OR 250? r GPD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: (,- , SQFT UNOBSTRUCTED AREA REQUIRED: C)-- SQF
e
BENCHMARK /REFERENCE POINT LOCATION: _
ELEVATION OF PROPOSED SYSTEM SITE IS p 1, [INCHE�SfF'T (ABOVE/BE2] BENCHMARK /REFERENCE POW
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: /ea FT DITCHES /SWALES: /ai" FT NORMALLY WET? [ ] YES [4 N
WELLS: PUBLIC: ,\ /%A FT LIMITED USE: ^ 114 FT PRIVATE: ,J /A FT NON - POTABLE: , \ F'
BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 'Z( FT POTABLE WATER LINES: /( F
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES (tt4 10 YEAR FLOODING? [ ] YES [..-T N
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: 4, ,7'c:.. FT MSL /NGV
/' ti
SOIL PROFILE INFORMATION SITE 1/% 'Mi./. (1 4
Munsell # /Color Texture Depth
to
)44-64 " to7'
_-�:— to
—_f — I
i to
to
1 to
to
to
c
USDA SOIL SERIES :/ .l /5� e-3
CL-
OBSERVED WATER TABLE: P/' / INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE /, BELOW ] EXISTING GRADE
HIGH WATER TABLE VEGETATION: [ ] YES [,a MOTTLING: [ ] YES [ ✓j NO DEPTH: INCHE
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: /
DRAINFIELD CONFIGURATION: [ ] TRENCH [1.--I
REMARKS /ADDITIONAL CRITERIA:
SITE EVALUATED BY:
DH 4015, 10/96 (Replaces HRS -H Form 4015 (Pape 3) which may be used)
(Stock Number: 5744 -003 - 4015 -1)
• ••• • •••
• AGENT: L/' . S • :,;( I �i•r •• r L ' � A.
- 4C •J (2 . •
.•. .• •
• . ■ •-• • • •
[Section /Township /RgngejPa:lce1•Na. as Tax ID Number
[
• • ••• • • • • .•,
•• •• • • • •. • >.
7
• • • • • •
• • • • • • • • •
• • ••• . •
-
•• • •
• • • ••• ••
SOIL PROFILE INFORMATION SITE 2
Munsell //Color Texture
A
r
i 7 4
�hl.� ) 1
USDA SOIL SERIES:
•
DEPTH OF EXCAVATION: le,
Depth
to
l to
to
to
to
to
to
to
to
INCHE
] OTHER (SPECIFY)
DATE : (/ 4 '--
J
Page 3 of
c:, 7,/ _7 /../_/
STATE OF FLORIDA . • ••• • •
• • • • • • • •,- ID • !
•• •• • • • •• •5 •,__
DEPARTMENT OF HEALTH : : : r: : :,..._-; -,-
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM COIVSTlyellS5N
C fl
Permit Applition N .. • •
..
• • • • • • • •
PART II - SITE PLAN- --- —::-, ----''...— —
• • •
• • • • • • •
Scale: Each block represents 5 feet and 1 inch = 50 feet.
--,
i • •...•-. • 4 0 .- ' • - Al* • • o
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' ---- -I ' ' • --t 4- : - ±. - - 1 1 r-i- - - -- - :
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1717 1 1, „ .
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Notes:
T
•
'
p/
/4 0 j4 J ipt
-r-
011 4015, 10/98 (Replaces HR.S.H Form 4015 which may be used)
(Mod( Number 5744-032-4015-6)
. . -
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Signature
Not Approved
Li
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11
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Site Plan submi e by.
Plan Approved
By
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ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
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Date
County Health Departmen
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