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933 NE 99 St (15)APPLICANT: AGENT: PROPERTY ADDRESS: j, if? 9 LOT: /(1) CHECKED [X) ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED. l l l l I l l l STATE OF FLORIDA DEPARTMENT OF HEALTH[ ONSITE SEWAGE TREATMENT CONSTRUCTION INSPECTION L t / /Os .4)4_ BLOCK: / 7 U SUBDIVISION: i'1 (CLIA t jF�dC L' TANK INSTALLATION ��; [01] TANK°$IZE [1/ () [1]_ (02] TANK MATERIAL ( [03) OUTLET DEVICE /)p i t,; Carly (04] MULTI - CHAMBERED [ (Y),/ N ] / [05] OUTLET FILTER � � �% .� I " S?e./ [06] LEGEND /44- [07] WATERTIGHT .:. [08] LEVEL [09] DEPTH TO LID DRAINFIELD INSTALLATION [10] AREA [1J [ 2 ] — 2 c SQFT [11] DISTRIBUTION BOX _ HEADER l.." [12] NUMBER OF DRAINLINES (r [13] DRAINLINE SEPARATION [14] DRAINLINE SLOPE [15] DEPTH OF COVER [16] ELEVATION [ABOVE /BELOW] BM _ [17] SYSTEM LOCATION [ 18] DOSING PUMPS (19) AGGREGATE SIZE N': ;, / l /Cj, . [20] AGGREGATE EXCESSIVE,FINES [21] AGGREGATE DEPTH /) FILL / EXCAVATION MATERIAL [42] FILL AMOUNT [13] FILL TEXTURE [24] EXCAVATION DEPTH [15] AREA REPLACED ( 26 ] REPLACEMENT MATERIAL 11 C, `� O }- EXPLANATION`OF VIOLATIONS / REMARKS: [ [ [ [ CONSTRUCTION - [APPROVED /DISAPPROVED]: ti, /44 ! AND AND J? - installer / Cnntrartnr PERMIT NO. DATE PAID: DIPOSAL SYSTEM[ FEE PAID: FINAL APPROVAL RECEIPT #: SETBACKS [27] SURFACE WATER [28] DITCHES (29] PRIVATE WELLS [30] PUBLIC WELLS [ '31 ] IRRIGATION. WELLS [32] POTABLE WATER LINES [33] BUILDING FOUNDATION [34] PROPERTY LINES `f [35] OTHER FILLED / MOUND SYSTEM [36] DRAINFIELD COVER [37] SHOULDERS [38] SLOPES [39] STABILIZATION ADDITIONAL INFORMATION [40] UNOBSTRUCTED AREA (41) STORMWATER RUNOFF [42] ALARMS [ 43] MAINTENANCE AGREEMENT [44] BUILDING AREA [45] LOCATION CONFORMS WITH [46] FINAL SITE GRADING /' (47) CONTRACTOR r < A/C. 45 .5 [48] OTHER ({ ABANDONMENT (49) TANK PUMPED [50] TANK CRUSHED ..- , c, u PROPERTY ID #: /- __ & FILLED FT FT FT FT FT FT FT FT FT SITE PLAN 1.. 1 OC CND DATE: 'l - FINAL SYSTEM [APPROVED/DISAPPROVED]: - /A vt {_ r ,,;A S 131 C CND DATE :.} " 1/ 4L DH 4016, 10 /97 Editions May Be Used) Page 2 of 3 MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request il Date "! \��'0''LAC C4 Type Insp'n AM- 1 5. / Permit No. A ©ci 1 Name Address /1 / a 1 i _5 Company Phone# _11 2 s— 75 7'7 Inspection Date Approved Correction Re- Insp'n Fee ❑ .frQru Socieled Dat Type Insp' Permit No. Approved Correction Re- Insp'n Fee MIAMI SHORES'VILLAGE BUILDING DEPART 305- 795 -2204 Building Inspection Reque Name Address Company Phone # Inspection Date o Type Ins MIAMI SHO1ES!VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Req Date 0 Permit No. f L. ((— r3 c Name Address Company Phone # Inspection Date Approved Correction Re- Insp'n Fee - 71 hiv\I (4" ? /1) Permit No. Name Address Compan Phone # MIAMI SHORES =VILLAGE Lj BUILDING' DEPARTMENT - L } ' 305 - 795 -2204 \ �1 Building Inspection Request Date/ Type Insp'n Ji�ti -r jf Cf ,<i ) " )t r ` I)() (t Approved Correction Re- Insp'n Fee Inspection Dates /l / J () 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 P2, BUILDING Permit Nd. D4 PERMIT APPLICATION Master Permit No. FBC 2001 Permit Type (circle): Building Electrical Miami Shores Village Building Department �`�Plumbing ) Mechanical Roofing 756 - ���� Owner's Name (Fee Simple Titleholder)) /'J91 F2 K 671z-z- U Phone # Owner's Address 93,5 A/C 'QQi7-7 City n9 /I4 h? / J'i" /O, State FL OZ / b Tenant/Lessee Name Phone # Zip 3 3137 Job Address (where the work is being done) 9 3-3 NL 99T,u vim' City Miami Shores Village County Miami -Dade Zip .33/32 Is Building Historically Designated YES NO Contractor's Company Name L L- O Y2 A.1 27 1 77c Phone # 3 - ?3 7 7 6- 7 6 Contractor's Address .7, t A.J. / b Tti S722CC-2- ,,/ Cit /Yl1A/PI/ f�b,2L� State /�'Lo/ Zip 33/3 d Qualifier L'. L i? L C, OC,/ Z 77 Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit Tyv Type of Work: ['Addition DAlteration ❑New Er/Repair/Replace ❑ Demolition Describe Work: LPL -/.ECc rti�GL� / -14J 774n..p< Submittal Fee $ Notary $S ... 0 0 Scanning $ * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** 12x Training/Education Fee $ . 40 Permit Fee $ Radon $ Square Footage Of Work: e CCF$ 1 Technology Fee $ 6 �. Bond $ -D O 7 Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ 4 62..5 1 (Continued on opposite 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 CONDTITONERS, 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 property is subject to attach nt. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which o even (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be ;.pro e�� �einspection fee will be charged. Signature er or Agent The foregoing instrument was acknowledged before me this day of /V V l , 20 54, by M/q * 6LLfi > (ho is personall n t o me'r who has produced As identification and who did take an oath. NOT • ( Y P Sign: Print: L C `-.J`r L'Z E- My Commission Expires: 4'7fi * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * ** ** APPLICATION APPROVED BY: 1 IA Chc 10/14/03 (Certificate of Competency Holder) Contractor The foregoing instrument was acknowledged before me this 6' T! day of 11 ' ! 1 4 5 / , 20 O l / by / l b / E £ C 77 r Gilm is personally known tome,,br who has produced as identification and wh did take an oath. My Conunission ts: State Certificate or Registration No. Certificate of Competency No. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ** * * * * * * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: [ ]New System [ ]Existing System [ [ X )Repair [ ]Abandonment APPLICANT: Gallo, Mark AGENT: SR0001343, Crockett Lester PROPERTY STREET ADDRESS: 933 NE 99 St Miami Shores FL 33138 LOT: 16 BLOCK: 170 SUBDIVISION: Miami Shores [Section /Township /Range /Parcel No.] PROPERTY ID #: 11- 3206 - 034 -0250 [OR TAX ID NUMBER] 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. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ]Gallons SEPTIC TANK A [ 0 ]Gallons N [ 0 )GALLONS GREASE INTERCEPTOR CAPACITY K [ 0 )GALLONS DOSING TANK CAPACITY [ 0 ]GALLONS Q D [ 300 ]SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ 0 ]SQUARE FEET SYSTEM A TYPE SYSTEM: [ N ]STANDARD [ N ]FILLED I CONFIGURATION: [ N ]TRENCH [ N ]BED N F LOCATION TO BENCHMARK: 15.4' NGVD/ FF of Residence OTHER REMARKS: SPECIFICATIONS BY: Andre, Paul /[j , TITLE: APPROVED BX: Andre, Paul DATE ISSUED: 5/4/04 DH 4016, 03 /97'(Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4016 -0) (ostds_cone 4016 -1] CENTRAX #: 13 -SG- 207.22 DATE PAID: FEE PAID : $ RECEIPT . OSTDSNBR : 04-1672- -R ]Holding Tank [ ] Innovative Other ]Temporary [ NA ] MULTI- CHAMBERED /IN SERIES: [Y ] MULTI- CHAMBERED /IN SERIES: [Y ] [0 ]DOSES PER 24 HRS # PUMPS( 0 ] [ N ]MOUND [ N [ N ] I ELEVATION OF PROPOSED SYSTEM SITE [ 4.8 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 7.3 ] [ FEET ] [ BELOW BENCHMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.0 ]INCHES EXCAVATION REQUIRED: [ 30.0 ] INCHES 1- Install 900 gals. category -3 septic tank equipped with an approved filter. 2- The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with sec. 64E- 6.013(3)(f), FAC. 3- Install 300 sq. ft. of drainfield in bed configuration. 4- Invert elevation of drainfield to be no less than 8.60' NGVD. 5- Bottom of drainfield elevation to be no less than 8.10' NGVD. 6- This permit is not or additio s. it TITLE: Professional Engin Dade CHD EXPIRATION DATE: 8/2/04 Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PEMIT, Permit Application Number U' I /44 (0i PART II - SITE PLAN- / • )1 f 7 • ifs• - Scale: Each block represents 5 feet and 1 inch = 50 feet. -.44•44.41■441. .47 - - - ! H • : - I ..11 ■,; EtT -t• ' . r 4 `' fr-h, • i ' ' • 4 t • , 4 I • t 4 0 .4444 4- 4 .44 • • . -4 -I. -4-- r4 r" * ; T - 71. Hr -T 4._ L • • 4- , - Plan Approved By • . 1.- - , : " : 4 4 Site Plan submitt d by: - -,- f! -+ r"- DH 4015, 10 (Replaces HRS-H Form 4015 which may be used) (Stock Number: 5744-002-4015-6) 1 4 '" ! _4 4- 4 -4 • 4 ; . ' , • 0.41) TT Signature Not Approved H ' I" Nt t '1" =77-; " •-• ; ; 4 - .. - rf ! f ! -4- 4 ; _ • MUS ALL CHA BE APPROVED BY THE COUNTY HEALTH DEPARTMENT -- -1•21-, • , , . -••-, . ; , , ,, , •,.• - : - r • • . . . , • ., .__[.. 1 •._ • _ ' _t_. , . . , . ■ t—,--, 1 ;-. - _ 1 1 14 _ ,. 7 .1. ' ' si - 7 4 . I 1 1 ! ' . , - r - ' 1 -'-',. '' - ' t i i t " - T - + " T - ■ " 4 , 1' 1---- - 1 --1-- . ., ■ , . - t ' ' . 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Q7.16 et i3J - • ! .3 Tale Date County Health Department Page 2 of 3' STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS APPLICANT: (yin L D AGENT: LLOYD LOT: / G, / ?, /7 BLOCK: SUBDIVISION: PROPERTY ID #: J/_ 3 . , 21.91 ; _034_ 0 Z 0[Section /Township /Range /Parcel No. or Tax ID Number] 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: [✓ YES ( ) NO NET USABLE AREA AVAILABLE: .2 0 ACRES TOTAL ESTIMATED SEWAGE FLOW: GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2) AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE] UNOBSTRUCTED AREA AVAILABLE: BENCHMARK /REFERENCE POINT LOCATION: FL Lfi, L ELEVATION OF PROPOSED SYSTEM SITE IS INCHES FT ABOV S� (p �� ] [ F ELOW BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES: SURFACE WATER: A).,q - FT DITCHES /SWALES: /1J./9. FT NORMALLY WET? [ ] YES,tJ,C][ ] NO WELLS: PUBLIC: /V•A! FT LIMITED USE: A)/7 FT FT PRIVATE: 4.44/ FT NON - POTABLE: j� FT BUILDING FOUNDATIONS: 3 FT PROPERTY LINES: ,- FT POTABLE WATER LINES: /0 FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ 40 10 YEAR FLOODING? [ ) YES [ 1N NGVD 10 YEAR FLOOD ELEVATION FOR SITE : .lG . • 0 FT MSL /NGVD SITE ELEVATION: /0. Gj SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture lt r/ /O '-//2 S 1 / (2r -`vl `/ to (3 72r ` / 57q/UD tom / tit iX 7 /.2 S/=WD /0" to C)R -A/ ZPm0 to // // to /1 /i to If If to to /; // to USDA SOIL SERIES: uR. 51p1AJL.)), J2 / / Depth i. OBSERVED WATER TABLE: )A69. INCHES [ABOVE / EL0W] EXISTING_ GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION• - I'NCHES)( ABOVE -BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES [NO MOTTLING YES [ 1NO` DEPTH: /L)/)- INCHES DEPTH OF EXCAVATION: 5t) INCHES (SPECIFY) SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: j DRAINFIELD CONFIGURATION: [ TRENCH r) BED [ ] OTHER ' DD ,T REMARKS /AIONAL CRITERI2 ,/ (1 ,� (. ✓sA4/ /1, ,r1 (,(M 444 ( ) �LlYil.- L X() SQFT UNOBSTRUCTED AREA REQUIRED: 601) SQFT ,'? DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3) which may be used) (Stock Number: 5744- 003 - 4015 -1) SITE EVALUATED BY: 4 ?__ SOIL PROFILE INFORMATION SITE 2 Munsell #LColor Texture Depth /0 `/R .S /1 LIM/ O to (r L - / 5n/t0 to /1)" /D ''fP � / ,5nAJ.D )0 to /.r pE-/ ,fi UD to /I // to // .fr to /f /r to 1 1 // - to I / // to C../ USDA SOIL SERIES: (]:4M9NL l/ DATE: Page 3 of 3 Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 5/10/2004 Applicant: DARYL Owner: DARYL JOB ADDRESS: 933 NE 99 ST Parcel # 1132060340250 Plumbing Permit Permit Number: PL2004 -135 Contractor LLOYD NORTH DADE SEPTIC TANK SERVIDEdNttactor's Address: 750 NW 107 ST Local Phone: 305 - 754 - 3375 Page 1 of 1 Legal Description: 5 -6 53 40 MIAMI SHORES SEC 8 PB 14 -33 E9FT LOT 16 ALL LOT 17 & W16FT LOT Fees: Description Amount FEE2004 -4579 Building Fee $175.00 FEE2004 -4580 CCF $1.20 FEE2004 -4581 Notary Fee $5.00 FEE2004 -4582 Training and Education Fee $0.40 FEE2004 -4583 Technology Fee $4.37 FEE2004 -4584 Builders Bond $300.00 Total Fees: $485.97 Total Fees: $485.97 Total Receipts: $0.00 Permit Status: APPROVED Permit Expiration: 11/2/2004 Construction Value: $1,800.00 Work: REPLACE DRAINFIELD AND TANK Signed: (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 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: MIAMI SHORES VILLAGE BUILDING DEPARTMEN 305- 795 -2204 Building Inspection Requ Dat I Type Insp'n Permit No. t L 0 LI 1 -b Name Address 9_3 Company Phone # Inspection Date Approved Correction Re- Insp'n Fee Date Type Insp'n Permit No. MIAMI SHORES VILLACiE BUILDING °DEPARTMEN`'° . 1 305- 795 -2204 Nam Address Company Phone # Inspection Date Building Inspection Request Approved Correction Re-Insp'n Fee Miami Shores Village 'Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING Permit No. D l` 13 -6 PERMIT APPLICATION Master Permit No. PLO 4 - W� FBC 2001 Permit Type (circle): Building Electric Plu i g ` Mechanical Roofing Owner's Name (Fee Simple Titleholder) 1�9 : 6 0 Phone # 7 i�(o" CO- Owner's Address 9 5A ,S)t ( 4Q7 7 - 1 City /1114iP1 t SP ()Pe State f1�R / Zip 3a/irk Tenant/Lessee Name Phone # Job Address (where the work is being done) Pic AL 697/ 37. City Miami Shores Village County Miami -Dade Zip 51 Is Building Historically Designated YES NO Contractor's Company Name L L DY2) 'VO 77 cP% /G Phone # Contractor's Address .7S0 Ai 7 f/-( City in/kV/7 / 51/128 5 /� i State fLDIR / Zip 3 5/'3 e Qualifier / L / r7 r ° 20C T Architect/Engineer's Name (if applicable) Phone # $ Value of Work For this Permit L+/n). 0?) Square Footage Of Work: (1 Type of Work: ❑Addition ❑Alteration Describe Work: APT /G / 3A/K ❑Ne / w E Repair/Replace ❑ Demolition * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * ** ** * ** Submittal Fee $ Permit Fee $ C CCF $��U CO /CC Notary $S. 'D 0 Training/Education Fee $ t V Technology Fee $ L/ , • 3 -7 Scanning $ Radon $ Zoning Bond $ Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ (Continued on opposite side) - 11 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 property is subject to attachment. lso, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs se #'n (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be app .ved .rfd r:�s ection fee will be charged. Signature The foregoing instrumen day of limy , 20O5I, by ?ARK GM:L/) w to is personally known to rTeor who has produced NOT Sign: Print: YP L My Commission Expires: State Certificate or Registration No. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * APPLICATION APPROVED B Chc 12/15/03 gent as acknowledged before me this As identification and who did take an oath. �. LS7t 9 li;t�: t, t . NOTARY P Y COMMISSION # 00 014762 ;' S • Ili�f FxPIRES:May20,2005 Thru Budget Notary ScMco Print: My Commission E'xj i ds: Contractor The foregoing instrument was acknowledged before me this 6/ day of ,/V>f , 200, by LL12 C C /el°TT �o is personally known to Ar who has produced as identificati . • ' did take an oath. ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** (C rtificate of Competency Holder) Certificate of Competency No. * !********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * ** * * * * * * * * * * * * * * * * * * ** Plans Examiner Engineer Zoning Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 5/10/2004 Applicant: DARYL Owner: DARYL JOB ADDRESS: 933 NE 99 ST Parcel # 1132060340250 Permit Status: APPROVED Permit Expiration: 11/2/2004 Construction Value: Work: ABANDON SEPTIC TANK Signed: (INSPECTOR) Plumbing Permit Permit Number: PL2004 -136 Contractor LLOYD NORTH DADE SEPTIC TANK SERVICIEdNtiactor's Address: 750 NW 107 ST Local Phone: 305 - 754 - 3375 Page 1 of 1 Legal Description: 5-6 53 40 MIAMI SHORES SEC 8 PB 14 -33 E9FT LOT 16 ALL LOT 17 & W16FT LOT Fees: Description Amount FEE2004 -4574 Building Fee $175.00 FEE2004 -4575 CCF $0.60 FEE2004 -4576 Notary Fee $5.00 FEE2004 -4577 Training and Education Fee $0.20 FEE2004 -4578 Technology Fee $4.37 Total Fees: $185.17 Total Fees: $185.17 Total Receipts: $185.17 $400.00 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 responisibility for all work done by either myself, my agent, servants or employes. Signed: (Contractor or Builder) BY: Date PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Job Address £5S lug; (: 9 Q s Tax Folio Legal Description // 3Z 4 034 0,2-6 Owner/Lessee / Tenant e4ry e / ‘ 111 5 Al 4 Owner's A d d r e s s - I C 1 3 3 9 9T A f, , V77/0r, - ' 5 Q / /� p ri5 ,I (1)- State# CF-0, 05 Contracting Co. Municipal # Architect/Engineer Bonding Company Mortgagor Address Permit Type (circle one): BUILDING ELECTRICA PLUMBIN MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION Rep /ill?, Di Fe Historically Designated: Yes No Master Permit # Phone 361-5 757 /*73 Address aS lv ? i - / SS# a(07- /-_Xone 3 °5`'0259_/3 73 Competency #C FC 050 Ins. Co. Address Address Square Ft. Estimated Cost (value) / 5 O° 0 p 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 I a s regulatin nstruction and zoning. Furthermore, I authorize the above -named contractor to do the work stated. Signatur owner and/or C President at num esident FEES: PERMIT 3 : RADON 7 LORI MELISSA NESENMAN MY .11.6 6 EXPIIASS COMMISSION f rry CC &O 5£ 1 4800- 3•NOTARY Fla. Notary £E & c; - Co. Date APPROVED: Zoning Building Mechanical Plumbing +... LORI MELISSA Nr,..) AN iYCOMM:SS!Or3; :' '!id#0,5? ?fly .:XPIRE$:4 OT j N 1c: " ' icB g rt.rl44) Co. My C C.C.F. 1 .® NOTARY ° BOND 3 TOTAL DUE 3 3 C. J ate Electrical Engineering Scale: Each ,lock rebresents 1W0 feet and 1 inch = 40 feet. Notes: STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT_ Permit Application Number Site Plan submitted by: ?. 4 1 y - s ,A Q I Plan Approved By DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 -002 - 4015 -6) PART II - SITEPLAN Not Approved /17/}e �jl� ,tJ PSI ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Date i'�`�- A County Health Department tY P Page 2 of 4 i ) �. < r, 111 p iss .,---- s 4 I rt s _ A . �■ 1 1 3 ■ ■ ■ . LY 1 _I ■ ■ ■ -t i 11I Scale: Each ,lock rebresents 1W0 feet and 1 inch = 40 feet. Notes: STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT_ Permit Application Number Site Plan submitted by: ?. 4 1 y - s ,A Q I Plan Approved By DH 4015, 10/96 (Replaces HRS -H Form 4015 which may be used) (Stock Number: 5744 -002 - 4015 -6) PART II - SITEPLAN Not Approved /17/}e �jl� ,tJ PSI ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Date i'�`�- A County Health Department tY P Page 2 of 4 C NSTRUCTION PERMIT OR: ] New System Existing System /e ] Tank )!1_,r Temporary /Experimental ] Repair Abandonment Other(Specify) APPLICANT: AGENT: PL, 13 PROPERTY STREET ADDRESS:? n/ ex/ LOT: /7 BLOCK: 7 SUBDIVISION: 124/ .�,6 0 ]� PROPERTY ID #:// ,4 st_ 0 [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 ,SPECIFICATIONS L O GP 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: [ T D 4/O UARE FEET PRIMARY DRAINFIELD SYS 1 R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: r STANDARD [ ] FILLED [ ] MOUND I CONFIGURATION: [ ] TRENCH [�J BED [ ] F LOCATION OF BENCHMARK :/ 4 (A/ C Fb/ ifelo F/0c3 ( 464>71; 44 ,ut 4 I ELEVATION OF PROPOSED SYSTEM SITE t0.6 ¢7 LN ES /FT) ABOV BELOW] BENCHMARK /REFERENCE` INT E BOTTOM OF DRAINFIELD TO BE [ . ,,,,,C [INCH / FT] [AB E /BELL] BENCHMA)JREFERENCE PO T L D FILL REQUIRED: [ ] INCHES 0 T H E R APPROVED BY: -/ DATE ISSUED STATE OF FLORIDA DEPARTM OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Authority: Chapter 381, FS & Chapter 10D - 6, FAC EXCAVATION REQUIRED: ) ] INCHES SPECIFICATIONS BY: TITLE: .T TLE HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used (Stock Number: 5744 - 001 - 4016 -0) APPLICANT PERMIT # ( Est ° � DATE PAID °p;',,;° F FEE PAID $ 2 i 'e RECEIPT # eP CPHU EXPIRATION DATE: Page 1 of 2 BUILDING ELECTRICAL PLUMBI01,p Owner of Building Work to be perfo ed-under this Permit e 1 Architect 4 d s � Bl. Co tractor ) j �t or wilder/ f Le Desbription Address of Building L • it v f This permi s granted to the contractor or b : er named above to construct the building or to install the equipment o device described in the appli- cation herefor in s ict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any i plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time 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 granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowIed of the ordnances and regulations pertaining to the work covered hereby whether shown on the plans o drawjrigs or in the tat rents or specifications thyf lie ass yes respon- sibility for work done by his agents, servants or employees. 7 ,x Sign:. A / In consideration of the issuance to me of this permit I agree to pet .rm the work covered hereunder in compliance with all ordinances and4egjleons pertaining thereto and in strict conformity with the plans, drawings, s ements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by myself, my, gent, servant or employee. BY CONTRACTOR OR BUILDER MIAMI SHORES VILLAGE, FLORIDA DATE j ' RMIt lr? 6277 ;, Contractor's . 's ,ense No r Subdi- vision Value of Project Amt. o Permit INSPECTOR B� • —‘ AUTHORITY AUTHORITY 194