131 NE 101 St (4)Date 1 I - a'OC O Job Address 131 Re 101 Reel Tax Folio
Legal Description I OT 18 `i ( q $ L_K )4 t t qrV . Histon G ND. 2
clly Designated: Yes No
Owner/Lessee / Tenant Al O t PAN i e
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Owner's Address l 3 I 14 ST 3313
Contracting Co. 3FPT\G C CNNFC tOMS 1 4C.
Qualifier 1 t Sf (SO LOr-to
State # 6Pt0 6 18081& Municipal #
Architect/Engineer
Bonding Company
Address
Address
Mortgagor Address
Square Ft.
OWNER'S AFFIDAVIT:
construction and zoning.
Signature
No
My
426 / 2 E36 fix
P .
•
ueSERESA J. SOLOMON
MY COMMISSION # CC 854806
EXPIRES: Jul i.003 1-800:3-NOTARY Fla. Notary Service a ar+ilnp Co.
•
� owner an • or ondo President
FEES: PERMIT
APPROVED:
Zoning
Mechanical
RADON
Date
Date
C.C.F.
Estimated Cost (value)
Electrical
11-3 0/9- ) 93
Master Permit #(
Qt) Y 8-6.60
Phone (3cS) ' S6 — 7 x-20
Address pb &DX 3866 H-OC c i 00D, 33 °8
SS# Phone (30S
Competency # — Ins. Co. N &TI LA L
Permit Type (circle one): BUILDING ELECTRICAL LUMBIN MECHANICAL ROOFING PAVING FENCE SIGN
WORK DESCRIPTION IN STgU l . z) TI && e-S rS E(°TI C a (z) EL CLS
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.
I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
Furthermore, I authorize the above -named contractor to do the work stated.
&1 ,,, rk /
er- Builder Date
fv �� ✓ ���
otar4 as to font actor or Own- il(f'r NO TAKYSI:AL
R Date
• y Commission Expires J
NOTARY PUBLIC'SfATE OF FLORIDA
COMMISSION NO. CC714103
MY COMMISSION EXP. MAR. 1,2002
BOND
TOTAL D
fJ
Structural Engineer
CONSTRUCTION PERMIT FOR:
[ >] New System [/J] Existing System
( 0 Repair []J] Abandonment
dicier IliJ(td
PROPERTY STREET ADDRESS: /3/ AiQ G
APPLICANT:
' (4) ?j J 5 BiOCK:
PROPERTY ID 1/: /t .Q��� , ®
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE. WITH SPECIFICATIONS AND STANDARDS OF CHAPTER 10D -6,
FAC. REPAIR'PERMITSiAND HOLDING TANK PERMITS EXPIRE 90 DAYS FROM THE DATE OF ISSUE. ALL OTHER
PERMITS EXPIRE ONE YEAR. FROM THE DATE OF ISSUE. DEPARTMENT OF HEALTH 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
.(c,o 1
A" [ x
'N
K
[
D [ z e6,1 SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ (+2k) SQUARE FEET 2 l t)n / p O4 SYSTEM
A TYPE SYSTEM: [ ] STANDARD [ ] FILLED
I CONFIGURATION: [, ] TRENCH [ ] BED
N
F
I
E
L
D FILL REQUIRED: (1J ) INCHES
LOCATION OF BENCHMARK: / Or 20 1 /` ' • ` 7 J . �� Z ®u ¢ ' (10ea ei. dAva d
ELEVATION OF PROPOSED SYSTEM SITE (&,O3] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
BOTTOM OF DRAINFIELD TO BE [ 'L � ] [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
T
8 JR,' 4- C= .1996 -1(A 0.7 O T . a. L . ( 8 a411,
E
Oil 1)1'4 d,eId, e,1 el Pi,
a./
r
SPECIFICATIONS BY: (111,1,1,4.,i
APPROVED BY:
II1E ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
CONSTRUCTION PERMIT
' Authority: Chapter 381, FS &
( 4
SUBDIVISION:
D!i 4016. 10/96 (Replaces HRS -H Form 4016 (page 1) which may be used)
(Stock Number: 5744 -001 - 4016 -0)
Chapter 10D -6, FAC
[ / 4 ] Holding Tank
(o-JJ Other(Specify)
1 0 ! ; -f. •
AGENT:
/414,0i 4a e5 (V v z
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
(OR'TAX ID NUMBER]
4 rmi -ter ( 80411)
[GALLONS /'GPD] SEPTIC TANK /AEROBIC. UNIT CAPACITY ' MULTI= CHAMBERED /IN SERIES:[ 1
[GALLONS / GPD] S "ea -b. CAPACITY MULTI- CHAMBERED /IN SERIES:[' ]
GALLONS GREASE INTERCEPTOR CAPACITY ,A [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS].
(
GALLONS PER DOSE DOSING TANK CAPACITY DOSE MATE [ ),PER 24 HRS NO.
EXCAVATION REQUIRED: [ 7 2 3 INCHES
C J ck f c;"1 (t 4 =3-t--/-0)
1 1 3 46
TITLE:
TITLE:
(
(
PERMIT # 00 tY
DATE PAID 3 - •
FEE PAID $' 7
RECEIPT # $ gg03/4'01.S"
[ /'J] Temporary /Experimental
] MOUND
.7
(
OF
PUMPS:
]
/2.0/15" ( 3/27/5`) '
Pbe; - f ti CHD
EXPIRATION DATE: / d / 2 11/2 0
Page 1 of 2
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number by County Health Department.
APPLICATION 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. (Health Department may require property appraiser ID# or
section /township /range /parcel number.)
SYSTEM DESIGN AND
SPECIFICATIONS:
TANK: Minimum specifications from Chapter 10D -6, FAC.
DRAINFIELD: Minimum specifications from Chapter 10D -6, FAC.
OTHER: Other specifications, such as operating permit requirements, low - volume flush toilets, variance provisos. •
SPECIFICATIONS BY: Name of individual providing specifications. If designed by a registered engineer must be sealed.
APPROVED BY: County Health Department personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by County Health Department.
EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repairs become void 90 days from the
date issued.
•
•
LOT:
*e tc
PROPERTY ID #: D / . 2 a-d
TO BE COMPLETED'BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUSX
PROVIDE,REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. -COMPLETE ALL
PROPERTY SIZE CONFORMS TO SITE PLAN:
TOTAL ESTIMATED SEWAGE FLOW:
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION: 11)10/ tit- �y. P �� eSee, ..�ax�.No'sa '� R n • ���
ELEVATION OF PROPOSED SYSTEM SITE IS ( • 0 [INFJ S /FT [ ABOVE /$ERg4),E E f pac:` /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN ,BE MAINTAINED FROM THE'PROPOSED SYSTEM TO'THE FOLLOWINGTEATURES:
SURFACE WATER: Nl FT :• DITCHES /SWALES: Alin FT NORMALLY WET? YES 414 ];NO
WELLS: PUBLIC: p( fir FT LIMITED USE AOW FT PRIVATE: if l- FT
"BUILDING FOUNDATIONS: r q,42 FT PROPERTY ' "LINES FT POTABLE WATERLINES: Vg, FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] ' YES [ 4 NO 10 YEAR FLOODING? .V p.) YES
[ b] NO
*YEAR FLOOD ELEVATION FOR SITE:
c. FT MSL /NGVD SITE ELEVATION; Doa7 0 " F MS /NGVD
SOIL PROFILE INFORMATION SITE 1
Munsell # /Color Texture
i 9 . et., ) e2, 94: A to
Depth
to Qero
f d to
to 00
to
O
•
to 7?.."
USDA SOIL SERIES: t.401N5 M ‹r ®j;
t:k
OBSERVED WATER TABLE: 1.1, [ABOVE / BELOW] EXISTING GRADE TYPE: [PERCHED / APPARENT]
e::,` \ [ ABOVE / BELOW ] EXISTING GRADE.
MOTTLING: .[ ] YES .[A DEPTH: 'e ...INCHES
SOIL f RATE FOR SIZING: °Q • -DEPTH OF EXCAVATION:
�" 7l•� INCHES
DRAINFIELD ATION t [ ` , ] , TRENCH, [ 4 BED. [ ] OTHER (SPECIFY) . "'
04TERIA. , n r�� 5 .: � -
1 / t f
to Q 0-3 o iv ' c%, v 1 ,LtJ - P-- 1.J ► 1. V , l Sz i M/ ccf ' -4 c fit J r .--,---- '
. I----/ t, 4 1 01-11 ( J44 4 4 I ° ' !w Two 1 "4+ r. .Q - 30 06 1 _ 7 200 "IA
1 11 `
'ESTIMATED WET SEASON WATER. TABLE °ELEVATION:
-HIGH WATER TABLE VEGETATION:-[, ] YES - [!./' NO
-
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM.
SITE EVALUAT,ION;AND SYSTEM SPECIFICATIONS
12,--Di .5 4457 47
BLOCK: SUBDIVISION:
/9
SITE EVALUATED BY !
DH 4015 10/96 (Replaces HRS -H Form 4015 [Page 3) which may be s elf
(Stock Number: 5744- 003 - 4015 -1') `
li V
[Section /Township /Range /Parcel No. or Tax ZD Number]
YES [ ] NO NET USABLE AREA AVAILABLE ®o"X G 7 ACRES
!� ®® GALLONS PER DAY [RESIDENCES -TI BLE 1 /' OTH R -TABLE 2 ]
$„ GALLONS PER DAY [1500 GPD /ACRE OR 2500 GP6 ACRE]
-67- UNOBSTRUCTED AREA REQUIRED: ' 4 ) j SQFT
SOIL PROFILE INFORMATION SITE 2
AGENT: c
Munsell # /Color
a ® � Ad°
•
Texture. Depth
T = 0,451 - . Y'S,ty�Q1
MPG
- F; ,
1 Q
,
USDA SOIL SERIES: / f p 81''
'r r:
Q 2 to.
'.-47,
a l(to
Qts
k, ()to
LEA to
`to /
`t
rS: / a
DATE:
PERMIT # 7/ N _ ®D 7 '
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:
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 1OD -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.
MINIMUM SETBACKS:
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.
FLOOD INFORMATION: Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation T
site and actual site elevation.
SOIL PROFILE INFORMATION: 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.
WATER TABLE: 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.
SOIL TEXTURE: 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.I. H.I.
H.I. [ - ]SHOT [ - ]SHOT [ - ]SHOT
APPLI
[
MAILING
STATE OF FLORIDA .-
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM -
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & `Chapter
ATION FOR:
New System [/►/] Existing System [A)] Holding Tank
[ AA
] Repair
APPLICANT:
AGENT:
ADDRESS:
Abandonment [A/] Other(Specify)
a4'
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. •
r -
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION OR DEED]
LOT: a YJ BLOCK:' ' SUBDIVISION: Gl ac., i h D OISI,oJ 1 / qe?
[Section /Township /Range /Parcel No.] ZONING:
PROPERTY ID # :// 3,,26 T `o / 3 /?3'0
PROPERTY SIZE: // 1, ACRES [Sgft /43560]
•PERTY STREET ADDRESS: 1 3) L f f I `
DIRECTIONS TO PROPERTY: '' _ , Is./ 1 At
2
3
• 4
•
M
•
BUILDING INFORMAT.
1 .5 01.0 r2',/ /
APPLICANT SIGNATURE:
/D) Mloa. i
DH 4015, 10/96 (Replaces HRS -H Form 4015'[F/age 1] which may be used)
.(Stock Number: 5744- 001 - 4015 -1) •
RESIDENTIAL ,
f
1 f
PERMIT #
'' PAID
FEE PAID $
RECEIPT # 2q'9 m1 W I 5
10D -6, FAC
J'1,e,L - )4¢
PROPERTY WATER SUPPLY: [/v] PRIVATE [J PUBLIC
(1%P<I la-wi ijE 51 '
TELEPHONE:
0 1 COMMERCIAL
Unit Type of �( : :{ "No: "of ' Building # Person
No Establishment IN Bedrooms ' Area Sqft Served
iZ/] , Temporary /Experimental
''Bu sine s's "`Act "iy ity ;,' - '
For Commercial Only
Spas /Hot Tubs g. [ : . ];, , Floor /Equipment Drains
ets`' [ ] (Specify) r
3 i b.
[ Garbage Grinders /Dispo ais
[ ] Ultra -low Volume FluSh.Wo
DATE: 5/1 / .q'
J1 J N,
la.
Page 1 of 3
INSTRUCTIONS:
APPLICATION 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, city, state and zip code mailing address for applicant or agent.
LOT, BLOCK,
SUBDIVISION:
Lot, block, and subdivision for lot (recorded or unrecorded subdivision). If lot is not in a recorded subdivision, a copy of the lot
legal description or deed must be attached.
DATE OF SUBDIVISION: Official date of subdivision recorded in county plat books (month /day /year) or date lot originally recorded. Dividing an approved
lot into two or more parcels for the purpose of conveying ownership shall be considered a subdivision of the lot.
PROPERTY ID #: 27 character number for property. (Health Department may require property appraiser IDN or section /township /range /parcel number.)
PROPERTY SIZE:
Net usable area of property in acres (square footage divided by 43,560 square feet) 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. Contiguous unpaved and noncompacted road rights -of -way and casements with no subsurface obstructions
may be included in calculating lot area.
WATER SUPPLY: Check private or public.
PROPERTY ADDRESS: Street address for property. For lots without an assigned street address, indicate street or road and locale in county.
DIRECTIONS: Provide detailed instructions to lot or attach an area map showing lot location.
BUILDING INFORMATION: Check residential or commercial.
TYPE ESTABLISHMENT: List type of establishment from Table II, Chapter 10D-6, FAC. Examples: single family, single wide mobile home, restaurant,
doctor's office.
NO. BEDROOMS: Count all rooms designed primarily for sleeping and those areas expected to routinely provide sleeping accommodations for
occupants.
BUILDING AREA: Total square footage of enclosed habitable area of dwelling unit, excluding garage, carport, exterior storage shed, or open or fully
screened patios or decks. Based on outside measurements for each story of structure.
# PERSONS: Number of persons residing, using, or working in establishment. For residential establishment, 2 persons per bedroom are
assumed.
BUSINESS ACTIVITY: For commercial applications only. List number of employees, shifts, and hours of operation, or other information required by
Table II, Chapter 10D -6, FAC.
FIXTURES: Mark each listed fixture with number installed or "NA" if not applicable.
SIGNATURE: Signature of applicant or agent. Date application on day submitted to Health Department with appropriate fees and attachments.
ATTACHMENTS: A site plan drawn to scale, showing boundaries with dimensions, locations of residences or buildings, swimming pools, recorded
easements, onsite sewage disposal system components and location, slope of property, any existing or proposed wells, drainage
features, tilled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, and
other pertinent facilities or features on adjacent property, if the features are with 75 feet of the applicant lot. Location of any
public well within 200 feet of lot.
For residences, a floor plan (residences) showing number of bedrooms and building area of each unit. For nonresidential
establishments, a floor plan showing the square footage of the establishment, all plumbing drains and fixture types, and other
features necessary to determine composition and quantity of wastewater.