320 NE 98 St (2)BUILDING
ELECTRICAL.
PLUMBING
KO OFING
Owner of
Building
MIAMI SHORES VILLAGE. FLORIDA
❑ PERMIT T° 4 Contractor's T195
❑ License No.
❑ Work to be performed under this Permit
architect
- jontractor
:r Builder
Legal Lot II
Description Bl
Address of
iuilding
Subdi-
vision
Value of
Project $
Amount of
Permit $
This permit is granted to the contractor or builder named above to construc 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,
irawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
ime 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
;ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
_'ertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work
one by his agents, servants or employees.
Signed. BY
INSPECTOR -'
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
-, ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
-opting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY
Village of Miami Shores
•
JOB Q_
ADDRESS
TIME READY A)
INSPECTION , S [FP - 7 - 4 a iK
REMARKS �` f 4 ' ens
N° 4969
INSPECTOR DATE ��' G
iUILDING ❑
ELECTRICAL ❑
PLUMBING ❑
HOOFING ❑
❑
Owner of
Building
Architect
"Jontractor
Dr Builder
.egal
)escription
Address of
wilding
Lot
MIAMI SHORES VILLAGE. FLORIDA
PERMIT N® 4117
Work to be performed under this Permit
Bl
DATE 195
Contractor's
License No.
Subdi-
vision
Value of
Project $
Amount of
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,
lrawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any
ime 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
;ranted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations
?ertaining to the work covered hereby whether shown on the plans or drawings cr in the statements or specifications and that he assumes responsibility for work
lone by his agents, servants or employees.
Signed. BY
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work covered hereunder in compliance with all ordinances and regulations
?ertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In ac-
:epting this permit I assume responsibility for all work done by either, myself, my agent, servant or employee.
CONTRACTOR OR BUILDER BY AUTHORITY
Village of Miami Shores
•
JOB 2,0 nsa
ADDRESS
INSPECTION , S crF P T s e.. P/ 1<
TIME READY 6 e . A
REMARKS `L �_ f cis �/ 4 !
INSPECTOR DATE
N° 4969
F
c A
•
CONSTRUCTION PERMIT FOR:
[ '] New System [1r' ] Existing System
[' Repair ( J Abandonment
APPLICANT:
PROPERTY STREET ADDRESS:
LOT:
PROPERTY ID l(
SYSTEM DESIGN AND SPECIFICATIONS
T
A
N
K
D
R
A
I
N
F
I
E
L
D
0
T
H
E
R
(
(
(
(
TYPE
SQUARE
SQUARE
SYSTEM:
1
1
CONFIGURATION:
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
Authority: Chapter 381, FS &
FEET
FEET
[ J TRENCH
LOCATION OF BENCHMARK:
ELEVATION OF PROPOSED SYSTEM SITE (
BOTTOM OF DRAINFIELD TO BE [
FILL REQUIRED: ( ) INCHES
DH 4016, 10/96 (Replaces HRS -H Form 4016 (page 1) which may be used)
(Stock Number: 5744 -001 - 4016 -0)
( <'J Bolding Tank [. ] Temporary /Experimental
[% J Other(Specify)
BLOCK: SUBDIVISION:
PRIMARY DRAINFIELD SYSTEM
SYSTEM
[ ) STANDARD [ ] FILLED
)
Chapter 10D -6, FAC
BED
AGENT:
[ SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 1OD -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. DEPARTMENT OF HEALTH 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.
1 [GALLONS / GPD] SEPTIC TANK /AEROBIC UNIT CAPACITY 1MULTI- CHAMBERED /IN SERIES:[ j
] [GALLONS / GPD] CAPACITY MULTI- CHAMBERED /IN SERIES:(
) GALLONS GREASE INTERCEPTOR CAPACITY (MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS)
j GALLONS PER DOSE DOSING TANK CAPACITY DOSE MATE [ ) PER 24 HRS NO. OF PUMPS: (
1 TITLE:
TITLE:
( ] MOUND [ ]
( J
J (INCHES /FT) [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
]„[INCHES /FT] [ABOVE/BELOW] BENCHMARK /REFERENCE POINT
EXCAVATION REQUIRED: [ ] INCHES
PERMIT 0
DATE PAID
FEE PAID s
RECEIPT 0
EXPIRATION DATE:
CHD
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
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 #: 27 character ID number for property. (Health Department may require property appraiser ID# 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 provisos.
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Health Department personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by County Health Department.
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.
® ,_
_ _;
I I 1 i 1
Iiil'Illl
( 7 /
Date
Scale: Each block represents 5 feet and 1 inch = 50 feet.
I i I I
I Y GRt1 1 1 _ ( I_
JI
Notes:
Site Plan submitted
By
0
STATE OF FLORIDA
DEPARTMENT OF HEALTH
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE
Permit Application Number G
II
II
I 1
II
Plan Approved
DH 4015, 10/96 (Replaces HRS-H Form 4015 which may be used)
(Stock Number: 5744 -002- 4015.6)
PART H - SITE PLAN
I .. _ I I I, ', I , r i! I
1i i' i1
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Signature
Not Approved
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
County Health Department
yd .4
the
Page 2 of 3