135 NE 98 St (11)BUILDING
ELECTRICAL
PLUMBING
ROOFING
Owner of
Building
Architect
Contractor
or Builder
Legal
Description
A/C127H
Lot
MIAMI SHORES
❑ PERMIT N°
Address of )5 W E ?Sh
Building /
In consideration of the issuance
pertaining thereto nd in strict conf
cepting this pe I assr;t: resp
CONTRACTOR OR B PER
/A`v
VILLAGE. FLORIDA /7�
DATE ` +�/ 195
6 871
Work to be performed under
LC,
Contractor's
License No.
this Permit mv ,
�'itl F f900 6;94- Yipp e
7#34ix._ /.emu 4:
Ct'OZE arim)
Subdi-
vision
Value of 1! Amount of
Project $ 1 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 application
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 thVtatements or specifications and that he assumes responsibility for work
done by his agents, servants or employees.
Signed BY-
INSPECTOR
me of this permit I agree to perform - •rk covered h reunder comp . once with all ordinances and re ations
ity with the ans, drawings, 'statements or pecift. • tions submi ed to the •r• .r authori r •res Vill ge In ac-
ility for all ork d• e • either, myself, y a• = servant or „
AUTHO
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
PERMIT # °�
DATE PAID /7 `- S FEE PAID $
RECEIPT #
CONSTRUCTION PERMIT FOR;
["-] New System [ Existing System [ ],Holding Tank [,, "] Temporary /Experimental
[NJ Repair [,;,'] Abandonment [- ] Other(Specify)
APPLICANT:
PROPERTY STREET ADDRESS:
LOT:
PROPERTY ID #:
SYSTEM DESIGN AND SPECIFICATIONS
T [
A [
N [
K [
D [<< -; ] " .SQUARE
R [ ] SQUARE
A TYPE SYSTEM:
I CONFIGURATION:
N
F LOCATION OF BENCHMARK:
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [
L
D FILL REQUIRED: [
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED: >"
[ ] STANDARD
[ ] TRENCH
1 INCHES
BLOCK: SUBDIVISION:
] [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY
FEET PRIMARY DRAINFIELD SYSTEM
FEET SYSTEM
[ ]
[' ]
AGENT:
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001 - 4016 - 0)
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6, FAC
REPAIR PERMITS AND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER PERMITS
EXPIRE ONE YEAR FROM THE DATE OF ISSUE. HRS APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. 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.
MULTI- CHAMBERED /IN SERIES:[ ]
] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ]
] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
] GALLONS PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ]
FILLED
BED
[ J MOUND [ ]
[
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
TITLE:
TITLE:
APPLICANT
EXPIRATION DATE:
CPHU
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number assigned by CPHU.
APPLICATION FOR: Check type of permit, if 'Other' specify type in blank.
APPLICANT: Property owner's full name.
TELEPHONE: Telephone number for applicant or agent.
AGENT: Property owner's legally authorized representative.
MAILING ADDRESS: P.O. box or street mailing address for applicant or agent.
LOT, BLOCK, SUBDIVISION or
PROPERTY ID/1: 27 character id number for property. (CPHU may require property appraiser ID 11 or section/township /range /parcel number)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 1OD-6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D-6, FAC.
OTHER: Other specifications, such as operating permit requirements, low- volume flush toilets, variance proviroa.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Public Health Unit (CPHU) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CPHU.
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the date
issued.
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIO �f RMJ
Permit Application Number ! - -I f f
Scale: Each block represents 5 feet and 1 inch = 50 feet.
III ,9 _..e „ IIII IIII I IIIII
i:iIi!i:i!iIIIIIII1IIIIIIoI1IIII
11111118M11111111I111111111ii1111M11111111111111111111111111111111111
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MNWW OM MOMMOM ■■■■■■■■■■■■■■■■■■■■■II■■ ■■■MEMO
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■MM■ARNP ■■r1OMMI, ■ i■■■ WAcirMINIS a■E■■■■■■■MMIWA■■O■■■.■ ■■■■■mr.ammii■■ ■EE■■■■
13111111111111i1A111111111111111111111111111l 111111111111111111111111111111111 1111111
■■■■■■■■■■■■ fl ■�! ■ ■7 ■I!J ■IIlA1 ■Irlll ■ ■ ■ ■ rrr■ rear; �■■■ a■ �■■■ ■ ■�■■s■ ■ ■ ■■ ■■■ ■■■■■■■■■■■■■ ■■■■
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Notes:
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744 - 002. 4015 -6)
PART II - SITE PLAN
Site Plan submitted" by: , .- P; ', Yw,s
SIGNATURE ITLE
Plan Approved Not Approved Date
` `7S
By County Public Unit
ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
Page 2 of 3
APPLICATION FOR:
[i% New System
[ii] Repair
APPLICANT:
AGENT:
MAILING ADDRESS:
LOT:
PROPERTY ID #:
Unit Type of
No Establishment
1
2
3
4
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
[ `y
v/
DIRECTIONS TO PROPERTY:
APPLICANT'S SIGNATURE:
/Existing System
Abandonment
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]
BLOCK: SUBDIVISION:
PROPERTY SIZE: j� ACRES [Sqft/43560]
.'
PROPERTY STREET ADDRESS:
BUILDING INFORMATION ()] RESIDENTIAL
No. of
Bedrooms
.H,
[ Tank
[(v] Other(Specify)
_, ✓
?,- : -
c
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744- 001- 4015 -1)
PROPERTY WATER SUPPLY: [ ] PRIVATE
[
] COMMERCIAL
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
TELEPHONE:
DATE:
!f
Temporary /Experimental
DATE OF
SUBDIVISION:'
[Section /Township /Range /Parcel No.] ZONING:
Building # Persons Business Activity
Area Sqft Served For Commercial Only
fir] Garbage Grinders /Disposals [lj Spas /Hot Tubs [/.,4 Floor /Equipment Drains
[. )/] Ultra -low Volume Flush Toilets (,-4 Other (Specify)
PUBLIC
Page 1 of 3
; or ?e1
ocine_'s
oi
in ,t-'._.1C,:.:: 'O, f` ..
f
APPLICANT: i
LOT:
PROPERTY ID #:
SITE EVALUATED BY:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK: SUBDIVISION:
a y
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: [',]
TOTAL ESTIMATED SEWAGE FLOW: ^''
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
SOIL PROFILE INFORMATION SITE 1
REMARKS /ADDITIONAL CRITERIA:
{ [Section /Township /Range /Parcel No. or Tax ID Number]
YES ( ) NO NET USABLE AREA AVAILABLE: ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE)
SQFT UNOBSTRUCTED AREA REQUIRED: < t SQFT
Munsell # /Color Texture
�c a
•
USDA SOIL SERIES: ' !' -� ��,.,�.�_
Depth
n to r ,
_•to ;;
to
to
to
to
to
to
HRS -H Form 4015, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 003 - 4015-1)
AGENT:
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING:
DRAINFIELD CONFIGURATION: [ ] TRENCH [4] BED [ ] OTHER (SPECIFY)
PERMIT #
ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
SURFACE WATER: ; _,:`o FT DITCHES /SWALES: ,.,C) FT NORMALLY WET? [ ] YES [ NO
WELLS: PUBLIC: Aly ' FT LIMITED USE: FT PRIVATE: FT NON- POTABLE: FT
BUILDING FOUNDATIONS: FT PROPERTY LINES: FT POTABLE WATER LINES: �r;� FT
10 YEAR FLOODING? [ ] YES [4
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [) NO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: FT MSL /NGVD
SOIL PROFILE INFORMATION SITE 2
Munsell #[Color
J ;
-
USDA SOIL SERIES:
Texture
., w} E �F�,1
Depth
C to
to
�t0
to
to
to
to
to
to
j(.
OBSERVED WATER TABLE: INCHES [ABOVE / tigimi4 EXISTING GRADE. TYPE: [PERCHED / A,PMENT)
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES [ ABOVE / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: [ ] YES [ ] NO DEPTH: INCHES
DEPTH OF EXCAVATION: :, INCHES
DATE:
Page 3 of 3
ENSTRUCTEONS:
17.ERWILT; 0: Permit tracking number assigned by CPHII.
APPLECA.1\17: Property owner's full name.
AC FENYT: Property owner 's legally
a:- S1J3DINTS:ON: Lot, block, ar.t9 subdivision fcr lei.
:?acy2:1•7! 27 character number lb? p7o)Cy. ttp?rcir,o::
Check if prope;A:y o!ze sito co: c..,; -
:II
normally wet drzinag3 .7".f.:11 C..' Cf.:C:7 1::::c17,
Accord fao
9e3.• day *vi33 2 ';;; • '.t1" • ;
1113 :
Lizt'cacks
1.
'
at.::01
c:, ;; • ••
inproo ; - • : : •
17,t:cort: "..„.
•
3,L •. .;.;:' •
3L. • ileco:36 ;;;;---; 3••;; 34; • -; -;
:73:EN 37::