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798 NE 98 St (6)** 'OWNER'S be don autho Signature Date: arm,. Coin APPROVED: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date Job Address -1 C P 93 ,>--)--- Tax Folioll .3 0 V // O? Legal Description /`'$ '7 e V 5,ie/2 Owner / Lessee / Tenant .....24- r , PIQUcm4q Yl Master Permit it 2 ®5"% Owners Address 7 7 Ee / V E- �8 S7�'ee,-1-- Phone Contracting Co. !7 A O/)/1P 1 L� Address IS 6 // A 02 9 4O Qualifier 04141gPr J6/'q(r4- State # Municipal # Competency # Ins.Co. Architect /Engineer Address i Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPT Sep--/- e, /G/? 0.7101 d d�G i/Tyco /S lYI;S Q // o r /o Square Ft. 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. FFIDAVIT: I certify that all the foregoing informat 1 is accurate and that all work will n compliance with all applicable laws regulating nstlruction and zoning. ''rthermore, I above- ed co tractor to do the work sta • m� GzC /�9 lthi � President er V � 0 o ? % I� s YC. ZSffilssion Expires J Jan. 21, 1996 :;of : Comm. No. CC 171522 * ' ' " * * * Zoning Mechanical President * ss# Phone c2/— c?4S * * Building * FEES: PERMIT g e 040 RADON C.C.F. / 8 NOTARY Fire , 2 0/9 ntractor or Owner- Builder i SEAL. BILLY C. COWING My Commission Expires Jan. 21, 1996 Comm. CC r71522 * ** TOTAL DUES /' 6'49 Other Electrical Engineering Authority: Chapter 381 Permit Is for: New System: Tank Abandonment: Owner: 5 p Y Design by: To BE COMPLETED BY f 1EALTii UNIT: Approved: Dy: STATE OF FLORIDA • DEPARTMENT OF HEALTH AND fEiiAfILITAT1vE stIVtcts PERMIT FOR CONSTRUCTION OF AN ONSITE SEWAGE DISPOSAL SYSTEM F.S. & Chapter 10D-0, F.A.C. ( -23 /9 Application /Permit Number Repair: Existing System: Experimental System (Temporary): Holding Tank: Other (t pec? y): Q V )/Y? Gt„.1 R incomptoto: Dls.pprov.d: Dote: / / . &/on: DIDDr,provod: 0.1.: / / n..aon: Dole !mod: G / // / , N <()Titration: 1 L D. ()Titration: / t ins -I I roan 4o Jan 1092 (0b90191n4 Al Pi viou. Edition.) GENERAL INFORMATION Telephone: (Work) (Home) Pro err Street Adding : Lot 0: 1 4- 2 t3lock #: 7 z .u txJMs on: /a"( . Unit: Section: Township: Range: Parcel Number: TO be COMPLETED by ENGINEER On COUNTY PUDLICIIEALT11 UNiT EMPLOYEES OiILY. SYSTEM 13 TO DE CONSTRUCTED IN ACCORDAN spear- ICA110NS ANO STANDARDS SET FORTY IN CIUAPTER 100 -9. F.AC. PEfMrts EXPIRE ONE YEAR FROM "DIE DATE OF ISSUANCE ANI RENEWAULE. REPAIR PERMrt! AND 110101110 TANK PE11Mit~S Exr ins so DAYS FROM DATE OF ISSUANCE. APPROVAL OF A SYSTEM DOE: GUARANTEE SATISFACTORY PERrORMANCE ton ANY Di'ECIrtc PERIOD Or TiME. SYSTEM DESIGN AND SPECIFICATIONS Design Sewage Flow from Table II 6 O OPD Most Restrictive Sol Texture Used tot System Sizing: Loading halo: 1 , 2 L Gnlione /Square Foot /Day Disposal system configuration: Trench: Minimum absorption area requirod:g- 5 U S Bottom of drainfieid absorption area rJt ust be Is Fill required? Yes No if Yes, What Is the Minimum Excavation fioqulrocl: Yes No Minimum Depth of Excavation: rt. Area Excavated: Unobstructed area required: q 6 Square Feet Unobstructed area available: /.p d-V Septic tank liquid copnchy: 1 Ds gallons Minimums Dratnfleld Area Required: 4 A 0 Laundry tank liquid copnchy: gallons Minimum Drolnflo(d Area Required: Gray water lank Ilqukl capacity: gallons Minimum Drainflold Area Requfrod: Aerobic treatment unit treatment capacity:.. gpd Draintleld Area Required: Grease Interceptor capacity: (*tons Dosing Tank: Capectty/Vofu me per Dote (circle ono): Molding Tank Capacity (must bo suttlslont to 11a , OX waste generet over a seven,Idey period): Ad Itlona onstructlon crlt • rla: 1 12 _ _ o � a-T�� e/ v Standard: Filled: Mound: Other: Bed: L.- Other(descrlbo): re teet inches abov. ,rtiow circle one) benchmark /fixed point of r of Fli Required: inc Sq Sty Sq Sr, Sr Sc; Title: Ii designed by a P.E. provide registration number: Place your seal upon the appropriate plans and ottr Application Received: / / R.v1eyeSd br 110: 1 / . MiUM of Ti. Paid: . cPttt1 Dole: / _ F -c E 0 0 • t .BS' K-- 5 S wK • 3 0 0 2.9.►o • „.E Wood. Pc rte.& ••• Lint X �1. . firth 87.75' CQK. 6' Heat,. 1 5.56 Poa.►cuJoY I7. Q Pa∎1 1.4 Mb Z5.1o N 130 • • 8.45' 0 • y 1 6' 0 o. J ( ; 3 -- r,I s. w4tit. • 0 4\1 E . co . o � c Z5.%5' y1 • 0 CO • J a o , p N • ) L 37. 55e- PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address 7 0 5 Tax Folio // Legal Il escription C 0 / Historically Designated: Yes No l/ Owner/Lessee / Tenant ) cam/ find 1.-</9 7 v17,R Master Permit # Date I Owner's Address Contracting Co. Qualifier State # ) 5d-in n 6 WORK DESCRIPTION Square Ft. 37c APPROVED: Zoning Mechanical )) *760 � dress SS #- Phone �.J8 Municipal # d A ) 16 Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRI No •. as to • er and/or ►, do r_ . t,-- , Date My Conuniss' .n tipix,% .... ' OFFICIAL NorA1Y ,Erg. w ee ANGELA M BECKER 2 Ip � COMMISOUN NUMBER a IT. :c° CC706697 9". .- PAY COMPASSION EXWRE F OF fk. NOV. 15,2002 FEES: PERMIT 4.. e '- RADON Building Plumbing 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. 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. Furthermore, I authorize the above -named contractor to do th tated. C.C.F. Estimated Cost (value) No rl as to C,, tractor o My Commission Expj Phone /n ANICAL 1R .„, OFING PAVING FENCE SIGN ,-1 t ^ l✓ ,�11 p ,�Ptiv Pie <. ANGELA M r Wi BECKER * ' i# OOMMs toN NUMBER '* Q CC786697 AAY COMMISSION EXPIRES CF F%. NT! 5 2002 NOTARY 5,0 CD BOND TOTAL DUFJ'4 /, 0 Electrical Structural Engineer STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND _ DISPOSAL CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ ]Holding Tank [ ] Innovative Other [ X ]Repair [ ]Abandonment [ ]Temporary [ IN ] APPLICANT: Kattoura, Michael AGENT: SR0921116, PARILLA ROBERT PROPERTY STREET ADDRESS: 798 NE 98 St Miami FL 33138 LOT: 1 -2 BLOCK: 70 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 014 -2290 [OR TAX ID NUMBER] SYSTEM DESIGN AND SPECIFICATIONS SPECIFICATIONS BY: RAM, APPROVED BY: Arrieta, Rolando DATE ISSUED: 1/25/02 J TITLE: TITLE: Engineer I CENTRAX #: 13 -SG -11626 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 02 -0233- -R SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 64E -6,FAC DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC TIME PERIOD. 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 PROPERTY DEVELOPMENT. T [ 1050 ]Gallons SEPTIC TANK MULTI- CHAMBERED /IN SERIES: [Y ] A [ 0 ]Gallons MULTI - CHAMBERED /IN SERIES: [Y ] N [ 0 ]GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 ]GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS @ [0 ]DOSES PER 24 HRS # PUMPS[ 0 ] D [ 400 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED [ N ]MOUND [ N ] I CONFIGURATION: [ N ]TRENCH [ N ]BED [ N ] N F LOCATION TO BENCHMARK: 11.50'NGVD FF E/R I ELEVATION OF PROPOSED SYSTEM SITE [ 2.1 ] [ FEET ] [ BELOW]BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 55.2 ] [ FEET ] [ ]BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES OTHER REMARKS: Existing 1050 gls. s/t to be pumped and a solid deflector installed on the outlet device, if needed. Install 400 sq.ft. [16 EQ -36 chambers] or available, but no less than 375 sq.ft. [15 EQ -36 chambers).The infiltrator system has to be same length lines, 1.0' min. cover. The existing suitable soil in the site can be used, previous confirmation of that. condition in the required area, plus 1.0' all around the perimeter. to 42" depth from the existing grade. Invert elev. of d/f no less than 7.40'NGVD Bottom of d/f elev. no less than 6. 90'NGVD T1 IS ?ENO IS NOT FOR Mf OWTION M INVENT ELEVATION. 1•`+v THE SEPTIC TA�l:( ?'r��!lLL OE PJU, F9 fi?P7t3 h SOLID p q +� - ( .70' N� vd BEFLrCTIO0 DEVICE !KSIAd�W bid TR OUTLET TEE 01 OF ®noon•► ELEVATION Dade CHD EXPIRATION DATE: 4/25/02 DH 9016, 03/97 (Obsoletes previous editions which may not be used) (Stock Number: 5799- 001 - 9016 -0) tostds_cons -1] Page 1 of 2 Scale: Each block resents 10 feet and 1 inch = 40 feet. � J Air- qo 5' Notes: L; 1 7 1 -- EA S � / Ug-/ / ttp Site Plan submitted by:_ Plan Approved D)1 2y 1 02 By -STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL Pe Application PERMIT cation � ����` n a-5-41 PART II - SITEPLAN Not Approved 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) Date County Health Department Page 2 of 4 APPLICANT: LOT PROPERTY ID #b SITE EVALUATED BY: • STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS d (� j l 4 at's ,cam , /,...� : -�J N BLOCK SUBDIVISION: Si-L r fJC� 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. 1 PROPERTY SIZE CONFORMS TO SITE PLAN: [( [ ] NO NET USABLE AREA AVAILABLE :U a ACRES TOTAL ESTIMATED SEWAGE FLOW 4 r 4 a) GALLONS PER DAY (RESIDENCES-TABLE ,J 1 /—Q / .TA 2] AUTHORIZED SEWAGE FLOW: `� �� ‘ 0 ALLONS PER DAY (1500. GPD RE ` O R 00 rGPD CRE UNOBSTRUCTED AREA AVAILABLE: (O T SQFT UNOBSTRUCTED AREA REQUIRED: 0 ® SQFT BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS SOIL PROFILE INFORMATION SITE 1 Texture -An to --- ��� --- 54J ,�` to to c Depth () DH 4015, 10196 (Replaces HRS -H Form 4015 (Pape 3) which may be used) (Stock Number: 5744 -003 - 4015 -1) USDA _SOIL SERIES: RiU /U - OBSERVED WATER TABLE: V° ,_, INCHES [ABOVE / ESTIMATED WET SEASON WAT R TABLE ELEVATION: HIGH WATER TABLE VEGETATION: [ ] YES 0<] NO PERMIT # Dq.:06? [Section /Township /Range /Parcel No. or Tax ID Number] ,/ [INCH rFT [ABOV BEL� BENCHMARK FERENCE PO THE MINIMUM SETB#1C]C HICH CAN BE MAINTAINED FROM THE PRO OSED SYSTEM TO THE FOLLOWING FEATURE SURFACE WATER: IJ�/ FT DITCHES /SWALES: AI FT N9RMALLY WET? [ ] YES ,L,1 NO WELLS: PUBLIC: L FT LIMITED USE: 4,,4 FT PRIVATE: a(//isf FT NON- POTABLE:1V 90 FT BUILDING FOUNDATIO S: FT PROPERTY LINES: 4 ; AFTT / POTABLE WATER LINES: /0 FT SITE SUBJECT TO FREQUENT FLOODING: [] YES ( NO 10 YEAR FLOODIN ?� YES [ ] NO 10 YEAR FLOOD ELEVATION FOR SITE: j1)T 4 FT MSL /NGVD SITE ELEVATION: ), FT MSL /NGVD SOIL PROFILE INFORMATION SITE 2 SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: 4 311A),C( / g DEPTH OF EXCAVATION: Munsell .lor Texture �p Depth 0 [!Nf /�ir• /l r to 10 A Aril to o f - -)4 AM /f' to ,lil>< - o USDA SOIL SERIES • :� t to BELOW] EXISTING GRADE. TYPE: [PERCHED APPARENT] 4 0 INCHES [ ABOVE / BELOW ] EXISTING GRADE. MOTTLING: [z ] YES [ ] NO DEPTH: INCHES INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH ] BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: 5 1111 ThJ • /flQ 01vl 5-L0-9-2Z21' DATE : i Dom° Page 3 of 3 INSTRUCTIONS: • PERMIT NUMBER: Permit tracking number by County Health Department. APPLICANT: Property owner's full name. AGENT: Property owner's legally authorized representative. LOT, BLOCK, SUBDIVISION: Lot, block, and subdivision for lot. PROPERTY ID NUMBER: 27 character number for property (property appraiser ID number or section /township /range /parcel number). PROPERTY SIZE: Check if property at site conforms to submitted site plan. Record net usable area available - lot area exclusive of all paved areas and prepared road beds within public rights -of -way or easements and exclusive of streams, lakes, normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: FLOOD INFORMATION: SOIL PROFILE INFORMATION: WATER TABLE: SOIL TEXTURE: Record the estimated sewage flow for the establishment from Table 1 (residence) or Table 2 (non - residential), Chapter 10D -6, FAC. Record the authorized sewage flow for the lot based on net usable area and water supply (1500 gallons per day per acre for private water supplies and 2500 gpd per acre for public water supplies). If authorized sewage flow does not equal or exceed the estimated sewage flow, the application must be denied. Record the square feet of unobstructed area available and the amount required. Unobstructed area must be at least 2 times as large as the drainfield absorption area and at least 75 percent of the unobstructed area must meet minimum setbacks in Chapter 10D -6, FAC. The unobstructed area must be contiguous to the drainfield. BENCHMARK INFORMATION: Record the location of the benchmark. If using a surveyor's benchmark record the actual elevation. Record the elevation of the proposed system site in relation (above or below) to the benchmark. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or "NA" for nonapplicable features. Features on site plan or within 75 feet of the applicant lot must be measured. The location of any public drinking well within 200 feet of the applicant's lot must also be verified. Record information on lot's subject to flooding. For Tots subject to flooding record 10 year flood elevation for site and actual site elevation. Two soil profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are required. Soil identification will use USDA Soil Classification methodology (Munsell colors and USDA soil textures). Refusals must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be determined. Record the depth of the observed water table at the time of the evaluation. Mark "perched" or "apparent" as appropriate. Record the estimated wet season water table elevation based on site evaluation, USDA soil maps, and historical information. Indicate if there is high water table vegetation present. Indicate if mottling is present and depth. Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION: If applicable record depth of excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIONAL CRITERIA: Record any additional remarks pertinent to site or installation. Ex. dosing required. SITE EVALUATED BY: Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ +) SHOT H.I. H.1. H.1. H.1. [ -1SHOT [ -1 SHOT [ - )SHOT • • .. • • •••• • • • • • • • • .. • • •••• •••• • • • • •••• •••• • • • • • • • • • .. .. .. • • • • • • • • • •••• • . • • •••• • • • • .. • .. • • • STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM .CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC CONSTRUCTION PERMIT FOR: �/ [ ew System [/] Existing System . [0�' ]/Holding Tank �]' [/ Repair [ [ Other(Specify) APPLICANT: y � i / 7 O , F AGENT: PROPERTY STREET ADDRESS: % LOT: c { BLOCK: 7 0 SUBDIVISION: ' Ato z _5";4 S PROPERTY ID #: [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. SYSTEM DESIGN AND S QIFICATIONS T [1 Jt ]' GALLONS, GPD] O lIZIl L D FILL REQUIRED: [ ] INCHES SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: SYSTEM [ ] STANDARD [ ] FILLED [ ] TRENCH [ ] BED HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744-001-4016-0) %E PERMIT # 'DATE PAID / • aP � FEE PAID $ RECEIPT # lA7W Q/� Temporary /Experimental 1 P1Jyy e,-.53v 14'4 , eq AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] CAPACITY MULTI- CHAMBERED /IN SERIES:[ ] [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS] DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] A [ ] [GALLONS / GPD] N [ ] GALLONS GREASE INTERCEPTOR CAPACITY K [ ] GALLONS PER DOSE DOSING TANK CAPACITY D [0 6 SQUAB FEET IMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET A TYPE SYSTEM: I CONFIGURATION: N F LOCATION OF BENCHMARK:. I ELEVATION OF PROPOSED SYSTEM SITE [. ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT [ ] MOUND [ . ] [ ] EXCAVATION REQUIRED: INCHES c6 <e. (V(2143- T QppLocam' TITLE: TITLE: CPH1J EXPIRATION DATE: Page 1 of 2 ::::NSTRT,f;;`•TiCNS: 1.;;•:.•••:.!..7 N 'POi:711: t rror-::•::eF.: as :;:y :':,.'..1-::.•,:i. Chr.•:, ty of' pc:. if "•C.::.:;:e:.;" :.. i',7,1z. APP;.':::AN•1:: ':;T:, OV.'::'fi '7'.21i '••;,'' 1.:1;:22:.. : : P;;;; :1:.• :' i•.';',71; .`.:•.'.': Sropoiiy oF.Vilt'.3 lefj6i; j :1o..;::- .".",;•:/... Li_ • ,..\.,:ji A:;•):"...)111SSi: ';?..-:). bmc OF ii:r:::,:l ra..:Iiin!. csie..._':-: nr.:. cEf,T.::: OT (Ecni. I .^1 J.:J..f.ICA, f•';:,L.V.,_.%•irittiaN OT ;1■..i.'.'.. ,.....'..7 :....;;;: 2.7 u;'::...T..; le, :-....o7:::::: 1:::: • •.:. (;..•:.. :::::y : :,:-.0i,:1 .:;; fn. ::::;c:::: 7., f.'`..1 . ...11:iSn\' ; S:..:::::;::"...'.:Cg7.7:f,•.s..INS: '...'1.;.•:\ K :uni F-.1::cific:::::inn.;; ":: .. :i9:;•:::::. 7AC. : . ?.."ills.:ouri tip,,cif:::::tiv: :..t: :;;71'.:::. :.1.3-6, :7' :::;Y:h:: .T:.:,:ifiLltiorl:•, i':;....,: ;;;: v,; : -...:::;-; ..;.:.-.7....:: ,- ;::rluircirrni.:...: : li',..v-vc!:::, 'liu..:;! i.c vcncc:T.:-.. ...: N1111:. of 1:: p7o,•.:q.. • .;;;. • :,;:-.t;.); :,e...,:sigT.N..1 2' a •olifi.%:..:4 , must :T: cuun iikiiitic '7„.,attl-. 'Jul... (c.. i .),::::.0,,Ac:. -.. c..:6.. ,•?!):‘ 1., - ,:; , :rinit i!, ii:ilie.!:: by :::::?••:i; !. 0 , :, fro.11 Lot.: i:,;.;..;,:it ':'.• ' ..;‘,;; '',::-.-: ::.;.:: . 11::l ir::;'..r.".':. :2o., ft::: :.;, ,It::: ',. btx:;:ri:::. vd:;; .33 f'.:33p: 'o:,1.1;.:C.. CONSTRUCTION PERMIT FOR: [ New System [].Existing System [f ]Holding Tank [rj Temporary /Experimental O [ ] Repair Abandonment [ ] Other(Specify) APPLICANT: ft 1 ®U AGENT: a _ 0 1 °��,�'� ✓c��9 ©fr PROPERTY STREET ADDRESS: g ger 4 � -e _ LOT:) BLOCK: 7 SUBDIVISION: 7 , , ,,,,,, ,3: '5 _ ' ; PROPERTY ID #: SYSTEM DESIGN AND SPECIFICATIONS T H E R STATE OF FLORIDA DEPARTMENT'OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC a SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: / 0 1_ 76 HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001-4016 -0) PERMIT # fpg: E a' DATE PAID ,./ . 0 ` 26 FEE PAID RECEIPT # [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] TITLE: TITLE: 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. T 0,p0 1 N Y GPD] SEPTIC 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 PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D 05 SQUAR FEET PP IMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED I CONFIGURATION: [ ] TRENCH [ ] BED N F LOCATION OF BENCHMARK: /V r I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE [ L D FILL REQUIRED: [] INCHES EXCAVATION REQUIRED: [ ]. INCHES [ ] MOUND [ ] [ [- ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT EXPIRATION DATE: r Page 1 of 2 CONSTRUCTION PERMIT FOR: f [)New System [ ] Existing System [W'] Holding Tank [ Temporary /Experimental M [ Repair [ ' Abandonment [ ] Other(Specify) APPLICANT: AGENT: PROPERTY STREET ADDRESS: F 'y _ � 1- LOT: d J °j BLOCK: SUBDIVISION: (` PROPERTY ID #: 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. SYSTEM DESIGN AND SpECIFICATIONS T [f2i jt) ] [GALLON' GPDp,,,S TIC 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 PER DOSE DOSING TANK CAPACITY DOSE RATE [ ] PER 24 HRS NO. OF PUMPS: [ ] D 0 SQUARE FEET P RIMARY DRAINFIELD 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 [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [_ - .-A INCHES p � r y ) p^' O Y i:C � f �.,�,.y- `c ? , f I -•. T:S °'*� 1 �. o-�t r �- C.�..�,. 1. ( 8 ,✓ r� , .�^...i: _ _ -.s. T �e e) . - 4 T H E SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D -6, FAC [SECTION /TOWNSHIP /RANGE /PARCEL NUMBER] [OR TAX ID NUMBER] TITLE: HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744-001- 4016 -0) DMOLDD OMO DC pG1R4O LENT TITLE Z ?c PERMIT # DATE PAID FEE PAID $ RECEIPT # Dy . l [ EXPIRATION DATE: CPHU Page 1 of 2 kJ Fl li ...'.:.�.::� I I k: Y 1'It it A1::.P5 uY: API'k!I;t; 13Y: ISSUEI): i X1'Il:Ai:DN J.)A+1 : u 1 .:i i2'1.'nir 'r1 •:n.:ci iccti t):;ti _., -. - ulti I'd . ^i 1- ,; :•A� --. _,i _ray ?,c.. • :, u-.,..c._tr_ a -. _ _ is AC. ..... ....,.tai:)_7:•, qu`,..,. _. ..w va it:: 1 i !:;t!: 1r dcGig c J� Ci �l :a'r�:6 1:?l8Ia•7.." must he :.enl..:C. County Public Health 'Unit (C? u1) :o..:::onncl rcvicwing r. a' appiovuua pen Date p,:rnit is :ssucd by CPr.:, On you: from data i .: _c . _i i> i :us not bean instcI :d. : r °or !T .1.,. repairs bccc: void 90 ciry!; rv:n i :7 :late ias 'ud.