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SEPTIC/DRAINFIELD-. Date Legal Description OW law PERMIT APPLICATION FOR MIAMI SHORES VILLAGE 6% Job Address 6% 11 q$ C5t Tax Folio Historically Designated: Yes No Master Permit # Z /9 O es Phone "1,51 Address ?- 0 £ f v 019 11 frig,/ c Pv 332V 6 C,o'b 4 �(bC-K ►ol Owner/Lessee / Tenant ,/ Owner's Address / / / f I ( -y a Contractin Co. aho vvrAll ) 1' i @, s U C. 4:1 Qualifier ( A\ Q A State # 9 — / i 67 Municipal # Competency # R Q Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAICLING) MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION �� C� i J�'t� v j ri r "( ev r Square Ft. 3b ( Estimated Cost (value) WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO 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.) Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I 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, SIGNS, POOLS, ROOFING and MECHANICAL WORK. 'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable nstruction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signature of owner •r Condo President • Notary as to Owner and/or Condo President My Commission:Expiresi (bv FV of riCIu ,sC fa :7V saAL O AP @ FAr�,).tA C� ' 1; 106 �(7, � col Flo^ our oa G,C11ri c <J1 OF F\ O n'1 Date FEES: PERMIT 35 RADON C.C.F. APPROVED: Zoning Building Mechanical Plumbin SS# - Phone 6 b 6 -06D t Notary as to Contractor or Owner - Builder My Commission Expires: : _ it P ,:V Pva 0E AL e ClirlDRR 1 Cn, , ;n7d'•i't FO /j NOTARY Date BOND 3 ® C TOTAL DUE 3 Y/, g LOT: BLOCK: 1T) 1 PROPERTY ID #: TO BE COMPLETED BY ENGINEER, HEALTH UNIT 1EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND MEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. i PROPERTY SIZE CONFORMS TO SITE PLAN: [ iYES [ ] NO NET USABLE AREA AVAILABLE : / /O/((4U ACRES TOTAL ESTIMATED SEWAGE FLOW: 303 GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] AUTHORIZED SEWAGE FLOW: 'RD GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: i O SQFT UNOBSTRUCTED AREA REQUIRED: (000 SQFT BENCHMARK /REFERENCE POINT LOCATION: /.®t crown. ® � CH .vowel ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINIED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURE SURFACE WATER: V\ FT DITCHES /SWALES: 1\ FT NORMALLY WET? [ ] YES /�[ 4 NO WELLS: PUBLIC: FT LIMITED USE: 0 FT PRIVATE: Vi FT NON - POTABLE: /d FT BUILDING FOUNDATIONS: .5 FT PROPEERTY LINES: , " FT POTABLE WATER LINES: 1Q) FT SITE SUBJECT TO FREQUENT FLOODING: ] TES [ ] NO 10 YEAR FLOODING? [ ] YES (Pf 10 YEAR FLOOD ELEVATION FOR SITE: , ® FT MSL /NGVD SITE ELEVATION: A FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 "" �oc) D nn$1, SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth p to to to to to i__toJ to to to USDA SOIL SERIES: OBSERVED WATER TABLE: 96 INCHES [ABOVE 6E1 ] EXISTING GRADE. TYPE: (PERCHED / 4 INCHES [ ABOVE) BELOW ] EXISTING GRADE. G: ( ] YES [ NO DEPTH: r ----°° INCHES ESTIMATED WET SEASON WATER TABLE ELEVATIO4: HIGH WATER TABLE VEGETATION: [ ] YES [ ] NO MOTTLING: EVALUATED BY: r ¥ Jy ri STATE OF FLORIDA DEPARTMENT OF HEALTH AND 1.tEHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS HRS -H Form 4015, Mar 92 (Obsoletes previous (Stock Number: 5744- 003 - 4015 -1) AGENT: )c\ cNC,\ itk SUBDIVISION: IIA.,‘‘Kq (Section/Township/Range/Parcel-1N°. or Tax ID Number] SOIL TEXTU LOADING ` A OR SYSTEM SIZING: /, 60 DEPTH OF EXCAVATION:a(O INCHES DRAINFIELD CONFIGURATION: [ ]_TRENCH [ ] BED [ OTHER SPECIFY) REMARKS /ADDITIONAL CRITERIA: ,p' x r SA. wtct *0/00; a t J t. `d AC4 n D t1A ®fb+ Cffe 1 w5A''l. It i 3iso ((ra1.4161I 1`�r/1. ?d"s h+ \ 4R. ) ('ort# 1 ro\ Iss cz rca DATE: ) / J "r / � i 7 Page 3 of 3 / editions which may not be used) PERMIT # C i Pr i' ) 00116--- Munsell Color USDA SOIL SERIES: Depth �to to to to to to to to Texture the of the b.:actin-L of the 1 t:I e: ncroe. ann :41 for cliareeter nun for pi:3?.e:1y. tipprniuti L C et: at.. .;..onitown. 17.1.:111110 t7ffeeb i ci corf L nt: prept roc.' dm:al:5Jc chic:it:1i, mt 1101."/ :r; 1V:2 . :114;con: C.10,1 :10i CALL:Z:1 0:: 1.;;;S:...:er ir mhtirouni tietbats wiih :ion 7Itl3' well ‘fithii... •lecorc o iot h anbjec" t•clut.1 hite elevation. ....wu tali] piofilef, within ilut identification will uie *USDA Soil ;).: clearly doeunitinted. aeeerd the depth of' the cripropriate. accot the es:inn:ed. 7 ,.ntlietite if city 5 tlitc L3Ititt• ptibi;c il;odica n. ' F1'011 c.:OW fOL' ay:get:tit LtIC Cl tc 75 17.,. , (..bovc o: fectotnu. withiii 75 fe. fcat of airo:lctin^L'a lo: . .7.)7. cubjec:1-, to a cnininiu niethatiolot3y (i`J:u if available, at th.; :hr of the ev; clevatio: 'I:C.1;i:: vegeta: O:'1LY2:11,!':j L ;711 apolieabi.; dent::: of tute.it• ,itteor: an . ty ZyT)c. or .A. 2. Mr: :2E2'016 C=3 Alva:Iv:410 Ic acea e:tit:t;alva. ect_trinenda /inf. encluuive t.:::ocata, ;ter. • 1 (retili:.;tiscc) 2 (nor --e..;r"er L',I:7,b1C :in& wa:et •tt public vfatc....1.. itath.o:iix...ts: tttiv:t b..: 2 are:i tht. :curd the t•ettni elCVLZ:0:). ; the lacnclinierli. act' ) :r.uat rectutl:ee: c: ..ff the aR?licart: bn lectiLlon hc verified. ":loc61:.5 co:r. 0 year flood :tit:ye:ion fot citc talc; .1 dept of '3 feet or 2.efuml t...Noit:ccl. Soil co:ore ciid 'US)A coil teni.e3). Tatifucalu mutt :d if the tterieu cannot he ch;:etanined. hfcrlc "pet ot ' :;ite evaluation, USDA coil Licati, end :1 9 :Indicate if mottilar, u:i d depth. S!:'fli 1:1;;;. docurnentztion M ) ) r cP By STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Number -1 HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744-002-4015-6) PART 1I - SITE PLAN Scale: Each block represents 5 feet and 1 inch 50 feet. Plan Approved '7 Not Approved ye l��i VI Y1 Po 1 \ \JA Notes: tXl 6) ` n Awe 4 4 - k C ` G t . 1 d raif YV)A1 Ai 4/)d 4 lf 96 rtvi 3619 MI Avg. A I RO acici . e e.(945 ` €-"wa,'9" J o‘) As 61 S $AON . 610 C' ®yaw. yk c{ t- A .t `1cJ -L In TEAR.. \rtQ 456, •10‘.0 vykrt< S g, 4 4.31 \AY4'a) I VYW A,4,h P - 0,444t 5(\5)-e Site Plan submitted by: SIGNATURE ALL CHANGES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT TITLE Date Q County Public Unit Page 2 of 3 4 3 ii7L yA AGENT: N 101011 AA MAILING ADDRESS: STATE OF FLORIDA PERMIT # DEPARTMENT OF HEALTH AND FEHABILITATIVE SERVICES DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ APPLICATION FOR CONSTRUCTION PERMIT RECEIPT # P y Authority: Chapter 381, FS & Chapter 10D -6, FAC APPL ATION FOR: [N New System [ ] Existing System 1 ] Holding Tank [U] Temporary /Experimental [ ] Repair [rl] Abandonment 17] Other(Specify) SSac U31 9 1 1 CYl i a m l 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] LOT: BLOCK: SUBDIVISION: _ DATE OF (� �� I ®1 SUBDIVISION: SUBDIVISION': 1 -Q1 yl [Section /Township /Rang_ /Parcel No.] ZOijING: JO PROPERTY ID #: PROPERTY WATER SUPPLY:_`[ ] inRINATE L )C?. , ] PUBLIC PROPERTY SIZE: /Q A ACRES [Sqft /43560] PROPERTY STREET ADDRESS: &yo 1\2 8 s DIRECTIONS TO PROPERTY: Q040, 1 t a , - E rri cJ BUILDING INFORMATION [)/] RESIDENTIAL [ ] COMMERCIAL / Unit Type^ f / / No. of Building # Persons Business Activity No Establishment /(./ Bedrooms Area Sqft Served For Commercial Only r [ ] Garbage Grinders /Disposals [7 ] Ultra -low Volume Flush Toilets APPLICANT' S SIGNATURE: Q ( -L \ DATE: / /9rb 7 HRS-H Form 4015, Mar 92 (Obsoletes previous editions iah` k not, be'us,e4) (Stock Number: 5744-001- 4015 -1) Qtr • 4 , .y //G TELEPHONE: 66/.._ 1 [ ] Spas /Hot Tubs [V] Floor /Equipment DYains [ 1] Otihe'r (Specify) Page 1 of 3 l`P • _ ;.ti. :' l: U. �.�� :_.. ',_ ;. •i. ^liar,. r�i ,: "j ,,..r;. :7f,' _.. -r ..Jf.U'f: .. ,� t': .. .�`1 :.U:. . .._.,!Li, _, bi!b iviitio'_ of ..., U.i101 i„V. a... .C:' .:.Cii 6. tor.(, :7!;f iL iL . 'y _ LdLr, S, m ' :.a'.:C; !1: road Lnti locale :1 county. nr!' :ion: to tut ur rP:; ! _.. ::v ::ocJ: lot iocttio:-. t i " ^::. _mould , ..,. 'it; ..(. , nC. `:^C.n•j7y� i no / ::17 '31!If; I,) CJ:Q?, T7Di71_.. l:D.,..,, I I C ! nrim i:iy for �'aIIC,_ . <.:Ydt. ; expi :c i :o :r., :..'c :yid{:: i7_C.7ing 000U!TICCdatic L`i for �i�:hllilhlC r,. ri . -. n c} "rL, L i: P �, ,.. ,) v% "') :, CF' �tt S:OYi. C'. C', _' Cr: C):' ully . to C d C Dt11!l:dt: ff:L' ..: ,..,__T!i!: fU' c't:h Liory ot bi.l :.iuiv. ;, v.rorlId , % Jr:a01; 1- , :1 ! .rat. ,.,;.. !1,, •, . on,. ^, n :h CONSTRUCTION PERMIT FOR: [ ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental [ ] Repair [ ] Abandonment [ ] Other(Specify) ■ y APPLICANT: WI, , AGENT: n o /, PROPERTY STREET ADDRESS: G i1 , 1 ,,E G €1 • LOT: 2 C BLOCK: SUBDIVISION: PROPERTY ID #: SYSTEM DESIGN AND SPECIFICATIONS f fl E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED: [ ] INCHES 0 T H E R DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, F3 & Chapter 10D -6, FAC gEiA 17 kii Eft SIl t n j @ ,r 4:P.1TP -' CH11.!'Pl P .:�, • OR 0.11JJ0( X95 3 h his n/., Ir. n I I V1 r • t LkV t'U _LL SPECIFICATIONS BY: APPROVED BY: e g a. ; 1 9 HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) Shoes [S CTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] D [ ] S UARE FEET PRIMARY DRAINFIELD lYSTEM R SQUARE FEET SYSTEM A TYPE SYSTEM: [ STANDARD [ /FILLED [ ] MOUND I CONFIGURATION: [ ) TRENCH [N/] BED [ TITLE: aPPLO©MF PERMIT # DATE PAID FEE PAID $ RECEIPT # SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WJTH 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. HES 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. T [500 ] r GALLONS./ GPD]� 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 PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] 0 F LOCATION OF BENCHMARK: (Y I( o �� B ®a ® as )0.0-v I.FM�` ' �c�� I ELEVATION OF PROPOSED SYSTEM SITE [ Q INCHE FT] [ABOVE / BENC MAR REFERENCE POI QR) ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXCAVATION REQUIRED: [ 3 ] INCHES / aeV� U- LA h� Uh L V 11 UU 1� �5� :, ':����' UNDER 0or Cfifd Cr �iFiA Si ;S4611 illr :AI L7 rik LEFORE 1-1IS PEr ?U HOT t�r��tsr !;.A7.17 /;urp� I • � 'd �r't. /.i? ;: 1�.. aO TITLE: 3preiQI,J 100 CPHU EXPIRATION DATE: y Page 1 of 2