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363 NE 98 St (3)1 -27 -2002 10:39PM facsimile transmittal TO : • ?f .0 n() ) _k)5 FR H (1 yj �,,,© C IL{;J RE: 7)e FROM MR ROOTER OF DADE CO 305 222 1372 P.1 303 N 9P.SI rck.rn - Shaye MR. FOOTER OF DADE COUNTY,INC. DATE: PAGES: P.O. Box 650638 Miami, Florida 33265 (305) 661 -2763 • (305) 885 -1206 (305) 956 -3778 • Fax (305) 222 -7372 Licens e4# CC- 000023- RF0038620 FAX : 3O - 75) - ' 3 :Luc / C,p/ Sk�e� / ✓` APPLICANT -1 r / _� • AGENT: ✓ \ . .: / •'..G. , � -.'� .. . PROPERTY. ADDRESS: 3.4. 3 A'• 4'- t) BLOCK: ' •// SUBDIVISION), ?'2.t -n.., ✓ ',. PROPERTY ID 1 t; .. ait � �..=..: srn¢s� .2m.....c..a sw. r. rc�.—. ww� :�'r.$�a�3i�S1�mE7L�ii�iR�ii. i.��i1Y � .� CHECKED (II ITEMS ARE NOT IN COM PLI) NCE WITH STATUTE' `OR 'RULE . AND: )GJST 'BE :'CORRECTS . . • 1 -27 -2002 10 :39PM ) 3 ] ] TANK INSTALLATION [01] TANK SIZE [1]90 ( .( (02] TANK MATERIAL re rv, [ 03 ] OUTLET DEVICE [04] MULTI— CHAMBERED [ Y j'] [05] OUTLET FILTER A ( 06] LEGEND / ,` [07) WATERTIGHT ''- y am' - -�. [08] LEVEL / ✓i � �. (09) DEPTH TO LID rx FILL [ (23] [24)• [25 [26] / EXCAVATION MATERIAL FILL AMOUNT / 2 '. FILL TEXTURE EXCAVATIpN D EP S ::1 AREA REPLACED. REPLACEMENT MATERIAL FROM MR ROOTER OF DADE CO 305 222 1372 STATE OF FLORIDA DEPARTMENT' OF HEAIiH ONSITE SEWAGE TREA; "MENT AND DIPOSAL SYSTEM CONS TRUCT.ION:.INSPEt. TTON, AND ;FIM3►L `APPROVAL DRAINFILLD INSTALLATION [ 101 AREA (1 ] / S X 7 0E 2 ] ? �J' ,I SQPT (11] DISTRIBUTION BOX xa;�DER • ( NUMBER of DRAINLINES (13] DRAINLINE SEPARATION' / [14) DRAINLINE SLOPE (15) DEPTH OF COVER `y • [16] ELEVATION (ASOVE1 1 r( { 17 ] SYSTEM LOCATION - ^ yam. -- (18 DOSING PUMPS . .� / :'" (19 ] AGGREGATE SIZE (20] AGGREGATE EXCESSIVE !Trims (21] AGGREGATE DEPTH / • • EXPLANATION OF VIOLATIONS: / R MASK: :: C_J • DISAPPROVED] ; _ _ ___ .4/(1 ( � ��..k " CONSTRUCTION (APPROVED FINAL SYSTEM (APPROVED/ DE 4016, 10/97 vious Editions Ray Be Used) Yin V' ..i∎ T1 • 'r•6•1i.+.ri1,rYf7R PERMIT . )itO. ( ") .) . , i. / DATE PAD; / :-",/ 7 • ri .%. FEE - RECEIPT • # s �••i C.' ' L SETP ACXZ �: [27 ] SURFACE WATER A) i (28] DITCHES f�.l` :,:,.;;':,,.•.. [29] PRIVATE WELLS . �/) •'�y FT (30] PUBLIC WEtS.B u ' / —q- FT 31 ] IRRIGATION WELLS A/ / ,= . FT ( ] "POTABLE WATER-' ` FT (33] BUILDING FOUNDATION , FT (34] ' - PROPERTY "'LIMES '; FT (351 OTHER FT FILLED i OUND .SYSTEiU - [ 36 ] DRAINPIEL.D "OOVBR'''" [37] SHOULDERS (38] SLOPES `. X3 STABILIZATION , ADDITIONAL INFORMATION [40) UNOBSTRUCTED ] [41) , STORNWATF R , RUNOFF ] [ .42 ] ] [43] NAINTI ANNE • ..Rob NT ) [ . BUILciNG• -A .3i►.�:,•:.,._ ... ] (45] . 'LOCATION. CQNNFORMS, WITH SITE PLAN ] ( 46] FINAL SITE GRADING •, y - A 1 [47 ) , CONTRACTOR 17 . 4/• ] (68] OTHER AeANDa T ' l [ 49 ] TANK PUMPED . / /. � _ 7 (50] - •Tux CRUSHED A TILLED P. 2 CND DATE:! CED DATE:/". V. ' Page 2 of'3 co a CONTRACTOR Name Pau l-, 5 ` c J / -rn 5 c J -� A ,� Name - n n 1 ye _ie License No. F `Zp 91 T Co C c.. 3 Address p b, 6 14 lfii � 33 f Telephone (06 ! 0T ,71 3 ( Fax 22 2 _f Q ualifier Name j‘49 Q t ( e /Udo , s e , PROPERTY OWNER Name Pau l-, 5 ` c J / -rn 5 c J Address 3 NE 9 e Si Home Telephone Business Telephone Fax TYPE OF MANAGEMENT (✓ ) New Construction Enclosure 4 Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'l Attachment Other Add'l Detachment _Other I III it 111111iUiililONNi INSTRUCTIONS - The'foll'owingisteps must be taken torobtaKa p emit from the Miami�Shore 41 1111 I. I I APPLICATION Job Address: 343 A 6- r F LC/ Address >> Apt. Folio Number // -at? V/ --1/4_5 6 Lot Z®� 2 ( Block Subdivision / Current Use of Property Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other ,v ARCHITECT Name License No. Address Telephone Fax PB /Q PG / PERMIT CHANGE Chg. Contractor Renewal Revision Extension Supplement Reinspection ( ✓) / , 9/ ( 5S' Description of Work City State ENGINEER Name License No. Address Telephone Fax PERMIT APPLICATION Master Permit No. Subsidiary Permit N ' o ' Ilage: II Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submitted 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. / e /) Zip 300 '7'6 Zoning Linear Feet Square Feet Units Floors Value of Worla #00 ' ^ Bldg Value Tax Assessed/Appraised Value Flood Zone Base Floor Elev. Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ 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 ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) SECTION Zoning Electrical Mechanical Plumbing Fife Public Works Structural Building Official BY DATE ❑ OTHER (Specify & Attach) $6 Soo, $ I (sq.ft. = x/I000 x ¢.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) PERMIT FEES TOTAL $3 ISSUING OFFICIAL DATE: CONDITION OF APPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com CONSTRUCTION PERMIT FOR [ �] New System (i!`'] Existing System [ 1 Repair [ N ] Abandonment p a-u1 1 wiCc .S+ APPLICANT: PROPERTY ADDRESS: SEP AL. (MIN) STATE OF FLORIDA DR . FT. (MTN) DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT 3 Co 3 e, 9 g S� �✓)<<<,a...,; "e(. LOT: Z o 1 Z I , : tra 1 s1(gk BLOCK: SUBDIVISION: [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] PROPERTY ID #: _ //- 3 0/ 3-5 4 0 [OR TAX ID NUMBER] c' SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY 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 TEE 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 DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS C= )L I S i-1 T [C100 ] O4g / GPD EPTIC TAN* /AEROBIC UNIT CAPACITY MULTI - CHAMBERED /IN- SERIES [ ] A [ _ ] GALLONS / GPD CAPACITY MULTI - CHAMBERED /IN- SERIES [ ] N [ — ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] K [ _, ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ] D (300) SQUARE FEET R [ -- ] SQUARE FEES, A TYPE SYSTEM: I CONFIGURATION: [ ] N F LOCATION OF BENCHMARK I ELEVATION OF PROPOSED E BOTTOM OF DRAINFIELD D FILL REQUIRED: [ / JPP 0 T H E R SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: PRIMARY DRAINFIELD SYSTEM SYSTEM STANARD [ ] FILLED [ ] MOUND [ ] TRENCH (V BED [ ] ( it 26 '0,G.u, 6 �- . �. (, /e✓. SYSTEM SITE (1.5h60] C E47FT] DolavEfulkoyDzurgotmARK TO BE (4S60] aNC ES,JSFT] [ABOVE4gAlgeli BENCHMARK REFERENCE POINT ] INCHES EXCAVATION REQUIRED: [50 ] INCHES t EZTA L OF Lot":�`d �r c(� E Y �v o p ! DH 4016, 12/99 (Page 1) (Previous Editions May Be Used) pt. l: Health Department pt. 2: Applicant pt. 3: Installer /Contractor pt. 4: Building Department [P] Holding Tank [1.)] Innovative [ 0] Temporary [ ] r:777.37 71 o9cn` :6+ n � a��l'Y+`el) VV � O 1 - i.,:,9 - c' _ ,fir �1 . (t i'�h• i9+o1; ale nit 4 �t� viou FI ra. 145 1�JI tr, id P a 'f✓y� PERMIT NO. 0 Z - 0 DATE PAID: /- / 7- Q Z. FEE PAID: 7 S 01 RECEIPT #: 4 '/ T,.r EXPIRATION DATE: ti lli,4.:, 6a. q 17 0 Z Page 1 of 3 CHD CNSTRUC a IONS: PERT U1T NUM ,o ER: Permit tracking number assigned by CPU-11U. ,•i CONSTRUCTION PERMIT 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. (CHI) may require property appraiser II D # or section /township /range/parcel number) SYSTEM DESIGN AND SPECIFICATIONS: TANK: Minimum specifications from Chapter 64E-6, FAC. 0 DRAINFIELD: Minimum specifications from Chapter 64E-6, FAC. OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. SPECIFICATIONS BY: Name of individual providing specifications. II designed by a registered engineer must be sealed. APPROVED BY: County Health Department (CHD) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CHD EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 99 days from the date issued. STATE! CAF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number Scale: Each block represents 10 feet and 1 inch = 40 feet. . Notes: C l. t i 1‘,J\ Site Plan submitted by \'K _ ✓ / Plan Approved ✓ ((- , Not Approved o Date I / 0 Z- By ! \ ti, .t r) , C (4-(?/ °_ t I �Cc�. , () Cdunty Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 - 002 - 4015 -6) PART II - SITEPLAN v ac S; Page 2 of 4 1 ■-■ r r 1 IN III MI r I i i t - 1 ( 1 1 1 ■ 1 - i- - -_ _1 z, 1 I I - 1 _ 1 I - _,.. ) ' I , 1 i '; 1 � T I J __ i 1 _i -4- w -- + } 1 I 7 ■ maw _ . . 1 L 1 6 A STATE! CAF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number Scale: Each block represents 10 feet and 1 inch = 40 feet. . Notes: C l. t i 1‘,J\ Site Plan submitted by \'K _ ✓ / Plan Approved ✓ ((- , Not Approved o Date I / 0 Z- By ! \ ti, .t r) , C (4-(?/ °_ t I �Cc�. , () Cdunty Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 - 002 - 4015 -6) PART II - SITEPLAN v ac S; Page 2 of 4 Date Type Insp'n Permit No. MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request For Inspector: ) / 9 Approved Correction /_ ❑ Re- Insp'n Fee Time 1 Name /-)/ Address 33 '" `� 9 5 6 Company © V 1 L ' Phone # L2 / ; c 0 ) 3