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PL-10-1069Project Address 622 NE 98 Street Miami Shores, FL 33138- 1132060171830 Block: Lot: SEBASTIAN CANNATA 1 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant SEBASTIAN CANNATA 622 NE 98 Street MIAMI SHORES FL 33138 -2522 Contractor(s) JOE LEWIS SPECIALTY SEPTIC (305)662 -7979 Phone CeII Phone Type of Work: SEPTIC TANK AND DRAINFIELD Type of Piping: SEPTIC Additional Info: INSTALL NEW Bond Retum : Classification: Residential Scanning: 1 Fees Due Bond Type - Owners Bond CCF Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $300.00 $3.00 $1.o0 $300.00 $3.00 $4.00 $611.00 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 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 myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL 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. Futhermore, I authorize the above -named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy June 28, 2010 Pay Date Pay Type Invoice # PL -6 -10 -38170 06/28/2010 Cash 06/11/2010 Check #: 1372 06/11/2010 Cash Bond #: 1972 Amt Paid Amt Due $ 261.00 $ 300.00 $ 50.00 $ 350.00 $ 50.00 $ 0.00 June 28, 2010 Inspection Type: HRS Approval Abandonment Final Rough Landscaping Date Available Inspections: 1 Inspector Cere C Date ) S O 1 Q) Address 6 Z. �, Alt g ? Pe vi?STDS # /2U 7` J 2 Y / Comments Signature DIVISION OF Environmental Health Florida Department of Health Miami -Dade County Health Department %TIM/Well Division 11805 SW 26 St: • Miami, FL 33175 S s 1 • Inspection Number: INSP - 145949 Permit Number: PL -6 -10 -1069 Scheduled Inspection Date: June 29, 2010 Inspector: Hernandez, Rafael Owner: CANNATA, SEBASTIAN Job Address: 622 NE 98 Street Project <NONE> Miami Shores, FL 33138- Contractor: JOE LEWIS SPECIALTY SEPTIC Building Department Comments June 28, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 For Inspections please call: (305)762 -4949 Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Septic Phone Number Parcel Number 1132060171830 Phone: (305)662 -7979 INSTALL NEW TANK AND DRAINFIELD Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Page 11 of 20 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING Q Q Owner's Name (Fee Simple Titleholder) so, 4.A 5 °/ivt i/471 Phone # 77( 2/ 3 3 Owner's Address 1 , /� n City /I f ok M • SJIaites State ('/ Zip 3 3 / 7S 1 Tenant/Lessee Name Email Job Address (where the work is being done) �� N Is Building Historically Designated YES Architect/Engineer's Name (if applicable) Structural Review. $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. PL I Q °" ∎ 0 (DS Master Permit No. Phone # Phone # Total Fee Now Due $ JUN 1 1'pi /4- City Miami Shores Villa e County Miami -Dade Zip 3 3 /75 FOLIO / PARCEL # //_3)_o_ »7 v NO ...../ Flood Zone JO s e, 6c Q Contractor's Company Name O C. L e. S Phone # .3 oS- 4 2 Z r 7$ 7 i Contractor's Address 3 O 75 —CA, 6I n ve City /v) /If} A R. !L State k' Zip 3 3 B Qualifier Name JO e.. I- Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone 305 a L 7/ 7 ) E -mail Value of Work For this Permit $ s,.j?Qf� Square / Linear Footage -Work: c," Type of Work: ❑Addition ❑ ENew Repair/Replace ❑ Demolition Describe Work: s / l �' et r rANk. 9 r",1 ri e II ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** F * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** s Submittal Fee $ Permit Fee $ ? CCF $ 6' co/cc$ Notary $ Training/Education Fee $ i' 0 0 Technology Fee $ 4 00 Scanning $ 3' 00 Radon $ DPBR $ Bond $00.00 Double Fee $ Violation date: a(gl•p0 See Reverse side -> Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose properly is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatur Owner or Agent The foregoing instrument was acknowledged before me this r 1 day of d , 20 (0 , by gt,a,{ . , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: * * * * * * * * * * * * * * * * * * * * * * * * * * * * APPROVED BY i` , (Revised 07 /10 /07)(Revised 06/10/2009) ,.�aaee aaaaaaaaaaassume aaaaaaaaaaaaaa 'TERESA J. SOLOMON .'a Comm# DD0733346 Plans Examiner Engineer Signature Contractor The forego g instrument was acknowledged before me this ff day of y . , 20 (0, by J ®e Lt a S who is personally known to me or who has produced Dew, Lice.n as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: , aa.aaaau a a �(� p � ~,d'o'.`rf.. Comm# DD0733346 • Expires 11/812011 My Commission Expic, *` Florida Notary Assn., Inc Expires 11/812011 Y J : ° >' , - * * ** 1'1 "+ * * *,*** el ******** * * * * ****** * * * ** ***** ** * * * * * ** ** * ** * * * ** * ** ** ✓ir l ll•1fl sf8 ammaS6S�rei®18t1� T `' a aEa[m eLa& Zoning Clerk checked Prepared by: Stanley Campbell, Esquire 1909 Tyler Street, 0306 Hollywood, Florida 33020 File Number. SD10.1 WARRANTY DEED THIS INDENTURE, made this 0 /1/ 2 8/ 10 between: Craig Doura, joined by his wife Janet Ray as Grantor`, whose address is: 380 NE 67 Street, Miami, FL 33138, and Sebastian W. Cannata and Katherine M. Doble, his wife as Grantee•, whose address Is: 622 NE 98 Street, Miami Shores, Florida 33138. Singular and plural are interchangeable as context requires. WITNESSETH: That the Grantor, for and in consideration of the sum of TEN DOWSRS ($10.00) and other valuable considerations to said Grantors in hand paid by said Grantee, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the grantee and grantees heirs forever the following described land located in the County of Miami -Dade, State of Florida , to-wit Lot 9 and 10, Block 101, Amended Plat of Miami Shores Section No. 4, as per plat thereof, recorded in Plat Book 16, Page 14, of the Public Records of M3ami -Dade County, Florida. Parcel ID Number: 11-3209-017-1830 SUBJECT TO easements, restrictions and reservations of record, if any, and taxes for current year and subsequent years. Said grantor does hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. F, Gran has hereunto set grantors hand . , seal the day and IN WITNESS artitten. WITNESS 1. Printed Name W1TWE B Printed Name NOTARYPUBLIC-STATEOFFLORIDA II Susan IC C ,, : MAR. 11, 2011 swam 3► • TICBOaotaG CO., nee State of Florida County of Broward Miami The foregoing Instrument was acknowledged before me on Janet Ray, who isle personally known to j � V � aliidd Photo Ident as ;dentifi, , 1 14a, oV 4 FLORIDA' DEED D D1VIDUAL WARRANTY DEED - OTT 1 1111 111 1111111 1111111 11111 1111 111 Peal) 04/28/ 10 by Craig Doura and has produced take an oath. My Commission Ezpir a& CF11 2010R0296330 OR Ste 27271 P9 24084 (1Ps) RECORDED 05/04/2010 1208 :15 DEED DOC TAX 3,090.00 HARVEY RUVIN, CLERK OF COURT MIAMI-DADE COUNTY, FLORIDA LAST PAGE sl- \OP Oon \ 1 Book27271 /Page2408 CFN #20100296330 Page 1 of 1 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: CONSTRUCTION PERMIT FOR: OSTDS Abandonment APPLICANT: Sebastian Cannata PROPERTY ADDRESS: 622 NE 98 St Miami, FL 33138 LOT: 15 -14 PROPERTY ID #: 11- 3206 -017 -1830 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 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. 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 T [ ] GALLONS / GPD CAPACITY A [ ] GALLONS / GPD CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D ( ] SQUARE FEET SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [] MOUND [ ] I CONFIGURATION: ( ) TRENCH ( ] BED [ ] N F LOCATION OF BENCHMARK: I ELEVATION OF PROPOSED SYSTEM SITE [ ] [ / ][ ABOVE/ BELOW 3BENCHMARK/REFERENCE POINT 0 T 11 E R SPECIFICAT APPROVE P o N Oapina DATE ISSUED: 06/09/2010 BLOCK: 10 SUBDIVISION: Miami Shores [ ][ E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: [ 0.00] INCHES EXCAVATION REQUIRED: [ / ](ABOVE/ BELOW 1BENCHMARK /REFERENCE POINT Have the tank abandoned in accordance with the following procedures:(a) The tank shall be pumped out.(b) The bottom of the tank shall be opened or ruptured, or the entire tank collapsed so as to prevent the tank from retaining water, and(c) The tank shall be filled with clean sand or other suitable material, and completely covered with soil.Have the system inspected by the health department after it has been pumped and ruptured but before it is filled with sand and covered. DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC v 1.1.4 AP968240 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SE - 1 APPLICATION #: AP968240 INCHES PERMIT # : 13-SC-1147144 DOCUMENT #: PR812802 EXPIRATION DATE: 09/07/2010 Page 1 of 3 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statues. Such proceedings are govemed by Rule 28 -106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The Agency Clerk's facsimile number is 850 -410 -1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 clays from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are govemed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. ;y APPLICATION FOR: [ ] New System [ ] Repair APPLICANT: STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT [ ] [ Abandonment ( € s i / 4 Existing System AGENT: Zc - 1s 1 ( ; . i ! MAILING ADDRESS: TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM /DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION LOT: /.f /''BLOCK: / 9 SUBDIVISION: / , i , PROPERTY ID #: 1/ -, 2 ' r 0/7-- ( I/M OR EQUIVALENT: [ Y / IU ) PROPERTY SIZE: d 2 / ACRES WATER SUPPLY: [ IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / N ] PROPERTY ADDRESS: 4 Z Z. /✓ DIRECTIONS TO PROPERTY: , c r: 0 /- . -) - e ! .# BUILDING INFORMATION 1 2 3 4 [ ] Floor /Equipment Drains v.r 6 7� -C 4 ,Iv," fl ¢A.. ] PRIVATE `PUBLam. ( ?J =2000GPD [ ] >2000GPD DISTANCE TO SEWER: FT 321.3' Holding Tank [ ] Temporary [ ] f' c TELEPHONE: <Z_ 121. r 4/s S ' .o c c t ,- .. [ ] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of Building Commercial /Institutional System Design No Establishment Bedrooms Area Spft Table 1, Chapter 64E -6, FAC PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: Innovative 3 -J j AP 9 . o -6'6 -,7;)7 PLATTED: � 9 3 3 [ ] Oyer (Spe,i) SIGNATURE: - y ,ta ? DATE: /: DH 4015, 10197 — Page 1 (Previous Editions May Be Used) Page 1 or 4 Stock Number: 5744 - 001 - 4015 -1 Site Plan submitted by: Plan Approved By /fl'v X DH 4015, 10/96 (Replaces HRS -H Form 4016 which may be used) (Stock Number: 5744-002- 4015 -6) STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCT ON PERMIT "itt Permit Application Number s 7, PART II - SITEPLAN Scale: Each block represents 10 feet and 1 inch = 40 feet. 4 / / i 3c' Notes: Signature prow -d 1 .i Title Date County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Page 2 of 4 CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Sabastian Cannata PROPERTY ADDRESS: 622 NE 98 St LOT: 15 -14 PROPERTY ID #: 11- 3206 - 017 -1830 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 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. 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 T [ 1,050 ] GALLONS / GPD Septic CAPACITY A [ 0 ] GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 225 ] SQUARE FEET SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [X] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [X] TRENCH [ ] BED [ 3 N F LOCATION OF BENCHMARK: F.F.E.: 11.44' NGVD I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E R THIS PERMIT IS NOT FOR ADDITIO �) [ 0.00] INCHES EXCAVATION REQUIRED: [ 24.00] INCHES . q P�� 1. 1— Install 1050 gal. category-3 septic tank equipped with an approved filter. 2 -The licensed coni or,�jrl5ta th ylitern` ap is responsible for installing the minimum category of tank in accordance with sec. 64E - 6.013(3)(l ' II 25.01# W a. drainfield in trench configuration. 4- Perimeter of excavation area shall be at least 2 ft wider and Ant egi'roposed absorption trench. 5 -Invert elevation of drainfield to be no Tess than 7.77' NGVD. 6. Bottom of "'Bald e ation to be no less than 7.27' NGVD. % fit I' - SPECIFICATIONS BY. PEDRO APPROVED BY: APPLICATION #: AP968241 STATE OF FLORIDA DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT #: DOCUMENT #: PR812994 Pe•. o N Ospina DATE ISSUED: 06 /10/2010 Miami, FL 33175 BLOCK: 10 SUBDIVISION: AP968241 TITLE: DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E- 6.003, FAC v 1 .1.4 3E819334 PERMIT #: 13-SC-1147145 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] [ 26.00 ] [I INCHES I/ FT J ( ABOVE A BELOW II BENCHMARK /REFERENCE POINT [ 50.00 ] [I INCHES I/ FT ] [ ABOVE / BELOW BENCHMARK /REFERENCE POINT Dade CHD EXPIRATION DATE: 09/08/2010 Page 1 of 3 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statues. Such proceedings are governed by Rule 28 -106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN # A02, Tallahassee, Florida 32399 -1703. The Agency Clerk's facsimile number is 850 -410 -1448. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are govemed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. APPLICANT: LOT: /3 BLOCK: / a SUBDIVISION: /� l / S as%' PROPERTY ID 1: f t-3 2 06 - 0 / 7 -/K3 0 [Section /Township /Range /Parcei No. or Tax ID Number) STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS AGENT: , _ ____ = = = = =m 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: (aelES ( ] NO NET USABLE AREA AVAILABLE: w a 9 ACRES TOTAL ESTIMATED SEWAGE FLOW: '3 p GALLONS PER DAY (RESIDENCES -TABLE 1 / OTHER -TABLE 2) AUTHORIZED SEWAGE FLOW: 7 V 4 GALLONS PER DAY (1500 GPD /ACRE OR 2500 GP6/ACRE -] UNOBSTRUCTED AREA AVAILABLE: 1 yo - 7 SQFT UNOBSTRUCTED AREA REQUIRED; . 4 (7`). � ° J .- SQFT r BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS To - g,J yam) _ � A � � � �� �i�.e�° ,[�CH AFTj [ABOVE / �E LO �W BENCHMARK /REFERENCE POT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: N/A. FT DITCHES /SWALES: /14 FT NORMALLY WET? [ ] YES [4,], -N0 WELLS: PUBLIC: #vf,4 FT LIMITED USE: /%/ FT PRIVATE: /0//1 FT NON- POTABLE: 'v/1 FT BUILDING FOUNDATIONS: j FT PROPERTY LINES: -, FT POTABLE WATER LINES: r, FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES (cO 10 YEAR FLOODING? [ j YES (6].'NO 10 YEAR FLOOD ELEVATION FOR SITE: " FT MSL /NGVD SITE ELEVATION: �, /7 FT MSL /NOVD SOIL PROFILE INFORMATION SITE 1 `;o' t DLO y P _ � � 0 SOIL PROFILE INFORMATION SITE 2 C /, # /Color Texture Depth i i i r s 5 A - r1 to 72 tO USDA SOIL SERIES: to to to to to to f11 kl/J W" d / `,,,,, OBSERVED WATER TABLE: SITE EVALUATED BY: OH 4015. 10198 (Replaces HRS -H form 4015 [Pape 3] which may be used) (Stock Number: 5744-003. 4015 -1) NCHES [ABOVE / ESTIMATED WET SEASON WATER TABLE ELEVATION: HIGH WATER TABLE VEGETATION: ( ] YES ( *NO SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: . 1.-IRENCi [ j REMARKS /ADDITIONAL ERITER%A• ew ELO EXISTING GRADE. TYPE: INCHES [ ABOVE / MOTTLING: ( ] YES ( j N [PERCHED / EXISTI TH: /1 41 _ INCHES / !11. / , ` DEPTH OF EXCAVATION: t' INCHES BED ( ] OTHER (SPECK? Munsell # /Color Texture Depth _ n ra`' to 9 S! e to to USDA SOIL SERIES: to to to to to I IA N • PERMIT # ARENT) DATE: 617:17-- Page 3 of 3 Scale: Each block represents 5 feet and 1 inch a 50 feet. Site PI n submitted by: Plan A , roved By STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number PART II - SITE PLAN ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT 0114015. 101911 (Replaces HR0-14 Fenn 4015 MO may be w.0) (stock Humber 5744.1102-40154) Title , Date 7 /20 County Health Department Page 2 of 3 ] Repair APPLICATION FOR: [ ] New System [ ] Existing System [ ]; ' Abandonment APPLICANT: SA1, a s „ C A .i&,i,4-y 9.,, AGENT: J a e C e, „ S ,Seer , /4 /l TE EPHONE: { 0 (1� ? . 79 ( MAILING ADDRESS: 3 () 7,5 s 4/ A r, c /� ' "i 7 J - 3 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST . � F. CQNSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS�TH APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLA1ED (MM /DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION 0 LOT: /5-/41 BLOCK: / 0 SUBDIVISION: /1'► c 3 PLATTED: / j 3 PROPERTY ID #: //- 3 0 2 , 0 - .i / / - /,' 3 J ZONING: le UM OR EQUIVALENT: [ Y /) PROPERTY SIZE: ACRES WATER SUPPLY: [ ] PRIVAT ` PUBLIC r <= 2000GPD v it>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ Y / DISTANCE TO SEWER: _ FT PROPERTY ADDRESS: b 22 /V, E. g Sf DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 STATE OF FLORIDA PERMIT NO. i _ '&41 DEPARTMENT OF HEALTH DATE PAID: -r1, -- 1, ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM FEE PAID: APPLICATION FOR CONSTRUCTION PERMIT R CIPT #: v /: LJf 9 S Fie [ ] • Holding Tank [ ] Innovative [ ] Temporary [ ] Cfre f 7(4 eiv [�] RESIDENTIAL [ t ] COMMERCIAL s Y li- �r1 S No. of Building Commercial /Institutional System Design Bedrooms Area Soft Table 1. Chapter 64E -6, FAC /v//4 [ ] Floor /Equipment Drains [ ] Other (Specify) ,{ SIGNATURE: DATE: i1 77`/(7 DH 4015, 10/97 - Page 1 (Previous Editions May Be Used) Page 1 or 4 Stock Number: 5744 -001 - 4015 -1 Notes: Site submitted by: Plan oved By . 01141115. 10418 (Replaces NI S H Foos 4016 Mich may be used) (soak Number 5T44- oo¢- 401114) Scale: Each block represents 5 feet and 1 nch .50 feet. 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