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171 NE 100 St (5)DATE: v' 2 - 20 0 7 ADDRESS OF FILE REQUESTED: Acknowledged by: FILE RETURNED TO: INITIAL Miami Shores Village Building Department 10050 NE 2 Ave, Miami Shores, Fl 33138 Tel: (305)795 -2204 - Fax; (305)756 -8972 PLEASE PRINT TIME: 3 2 2 / NAME OF PERSON REQUESTING FILE: V /17 0- 1 / / 2 7T PHONE #: 3 v 5 96/ - yZ-h YOUR ADDRESS: / 7/ /1/Z /00 r INFORMATION REQUESTED: p / �/� //-1//=(7-;L I understand that all documents in this file are property of Miami Shores Village and that NO documents may be removed from this file. You may get 4 complementary copies (8x11) size, additional copies will be furnished at 0.15 cents per page, not including any blue prints. If blue prints are order please be aware that we are not responsible for the quality of the printed documents. PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date °7 Job Address / 7/ (h r 10 0 S Tax Folio X Legal Description CC :f Designated: Yes No Owner/Lessee / Tenant (L O D. L a ✓ Master Permit # Owner's Address)( / 2 ( /L i / 0 t S 1 Phone 300 7S - /0 $ 6 Contracting Co. fg# /0 AC LYP7 G1 /F / ( J)12 / L IF k Address l W ©.4 .44. w ( ( C7 44 '» /t /hii Fl Phone 3d0 / g/.57�'S3' Qualifier -rig fa 4 4-41. State # , Stv/) no 28 3 9 Municipal # Competency # Ins. Co. Architect/Engineer Address Bonding Company Address Mortgagor Address Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL ROOFING PAVING FENCE SIGN // WORK DESCRIPTION (�4'7( Square Ft. Estimated Cost (value) i7 ,2Q 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 is t the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, ' LUMBING, 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 the work stated. Signature of owner Notary as to My Commis on FEES: PERMIT RADON o President Date 7' 0/ ent Date Dagoberto F Guardia *My Commission CC750345 ,, Expires June 11, 2002 APPROVED: Zoning Mechanical Plumbing Notary as to Contractor My Commission Expires: Signature of Contractor or 0 ilder Date 7-3/- F Guardia Date 'Son CC7so34$ res June 11, 2002 C.C.F. NOTARY r -- BOND TOTAL DUE 30 Building n Electrical Engineering rE L !1iti�Ls l: PERMIT APPLICATION FOR MIAMI SHORES VILLAGE Date q -4--6 P7 Job Address /7 1 JOE Tax Folio Legal Description Owner / Lessee / Tenant CA C 14fl Master Phone A Au- C t-1 L ndO e I "1 T339 S t3 112 S\ • Owner's Address 1 ui ( v1 E too ST Contracting Co. � l 0 �v N �- vJ S 1�4.,J ,) S'9 - 357 Qualifier ss# - Phone ���- P�c� -y.7t State it 0 tunicipal # Competency # Ins.Co. NI��■> Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL MECHANICAL ROOFING PAVING PENCE SIGN i.) s ., j , (446 r / 4►.rJw.! a)4-1 SDK WORK DESCRIPTION av Square Ft. Estimated Cost(value) f "� . so 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 permi are required for /ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK. rt tb Signature of owner and /or Condo President Date: APPROVED: Notary as to Owner and /or Condo My Commission Expires: ** * * * * FEES: PERMIT S . RADON President SHARON C. HOENES /9 My Comm Exp. 4/20 Bonded By Service Ins No. tC278556 11 Pr:axAY /Orin I 1 Ogle I. C.C.F. �. r7s r z Permit t L i a OD ify that all the foregoing information is accurate and that all work will all applicable laws regulating construction and zoning. Furthermore, I contractor to do the work stated. Signa 'e •ntractor or Owner- Builder Da r TIQRON C. SENES / My Comm xp. 4/20/97 � • ���IG tBar e o 2 C Ivi onlractor or Owner- Builder P on f Ito/0 V * * * * * * * *, 300 , 19 "' NOTARY TOTAL DUE 3 3 � '_ oO Fire Other Zoning Buildin_ _ Electrical Mechanical Plumb' Engineering CONSTRUCTION PERMIT FOR: stem [ 4--Er sting [ - ]-He3d ng__Tank [ e temporary /Experimental [ ] Repair [ 14— Abandenrment [ jJ Utner(speCify) APPLICANT: PROPERTY STREET ADDRESS: 77/ 4/ E 27 � 7 LOT: 2 / BLOCK: 457 SUBDIVISION: ,t PROPERTY ID #: STATE OF FLORIDA PERMIT # Y2 " 0 O DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES DATE PAID ONSITE SEWAGE DISPOSAL SYSTEM FEE PAID $ CONSTRUCTION PERMIT RECEIPT # Authority: •Chapter 381, FS & Chapter 10D -6, FAC //d41 S AGENT: A. .4 aiiJL� c S ��Jei/viC [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 /'4C C /�,t: /4 6 s U. T [ POD] [GALLONS / GPD] SEPTIC TANK /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 [ 00] SQUARE FEET PRIMARY DRAINFIELD SYSTEM R [ ] SQUARE FEET SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [ ] MOUND [ ] I CONFIGURATION: [ ] TRENCH [ /�^ }, BED . [ . ] /� F LOCATION OF BENCHMARK: <' G - C-/ o� G ' ! / Oa p ,/ . / .84 / I ELEVATION OF PROPOSED SYSTEM SITE [ Z 2jj [INCHE - ABOVE B •� FERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 4 [INCHE T [ABOVE •��.} BENCHMARK FERENCE POINT L D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 44g, INCHES O INSTAL 112' OF LOAF,' CO?,RE-1: BAND • T UNDER BOTTOM OF DP/E;'f: -;Z:LC H 1. _ , _ _ E f V jie 11 -.. � I R ...� :r. Y. iJ" � TITLE: SPECIFICATIONS BY: APPROVED BY: DATE ISSUED: zeffri . ' ' l . ga y.i:y� . i 7. � "i J2F �. ' 'lOi� `',` VICE (t SfALLEO ON THE UETLE T 17k TITLE: g. TITLE: HRS -H Form 4016, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744 - 001 - 4016 -0) APPLICANT A P a CPHU EXPIRATION DATE: 1;0 Page 1 of 2 °_NSTRUC7I :NS: ;i ' S211 ac NUMBER: Permit tracking number assigned by CPHU. A ?? 'iCA a ION FOR: Check type of permit, if " Cther" 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. C �4 SYSTEM DESIGN AND SPECIFICATIONS: LOT, BLOCK, SUBDIVISION or "' PROPERTY IDD: 27 character id number for property. (CPHU may require property appraiser ID 1/ or section/township /range /parcel number) 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 Public Health Unit (CPHU) personnel reviewing and approving permit. DATE ISSUED: Date permit is issued by CPHU. EXPIRATION DATE: One year from date issued if the system has not been installed. Permits for system repa'rc become void 90 days from the date issued. APPLICATION FOR: �....] E I st��g �9yst�e�►�� - Sa34 ng — ]- -Temparary /ExperimeI [J] Repair APPLICANT: � ELEPHONE t ' 1 S .dl� h c' 7 AGENT: - STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT` Authority: Chapter 381, FS & Chapter 10D -6, FAC MAILING ADDRESS: 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 RECO )rD SUB ISION, ATTACH LEGAL DESCRIPTION OR DEED] � C BLOCK: ( SUBDIVISION: pd LOT: PROPERTY ID #: PROPERTY STREET ADDRESS: DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 2 3 4 S FCC- [ ] Garbage Grinders /Disposals [ ] Ultra- low €Flush Toilets • APPLICANT'S SIGNATURE: e3 ► L S �- tE RESIDENTIAL No. of Bedrooms HRS-H Form 4015, Mar 92 (Obsoletes previous editions which may not be used) (Stock Number: 5744- 001 - 4015-1) PERMIT # DATE PAID FEE PAID RECEIPT # S � /7o f) itilyerad=5 7,‘.3 DATE OF SUBDIVISION: [Section /Township /Range /Parcel No.] ZONING: PROPERTY SIZE: � ACRES [Sqft /43560] PROPERTY WATER SUPPLY: [ ] PRIVATE I - (00. ° 4 — 612- _�. • (—LS\ C:)1 I1 • Building Area Sqft [ ] Spas /Hot Tubs [ ] Othey-(Specify) ] COMMERCIAL t # Persons:, o UL Business Activity For Commercial Only DATE. y_3 [ ] Floor /Equipment Drains 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: PROPERTY SIZE: , a a. Lot, block, and subdivision for lot (recorded or unrecorded subdivision). if lot is not in a recorded subdivision, a copy of the lot legal descrisdon 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. (CPHU may require property appraiser ID /I or section/township /range /parcel number. 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 o." water. Contiguous unpaved and noncompacted road rights -of -way and easements 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 100 -6, FAC. FIXTURES: Mark each listed fixture with number installed or "NA" if not applicable. SIGNATURE: Signature of applicant or agent. Date application one day submitted to the CPHU 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, filled areas, obstructed areas, and surface water. Location of wells, onsite sewage disposal systems, surface waters, end 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 bedronms 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. STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTIQN PERMIT g7/ 0745' Permit Application Number PART II - SITE PLAN Scale: Each block represents 5 feet and 1 inch = 50 feet. r4\ I ti _.a. !.:- S �L- I Pt, O 1 i Notes: E�1 ST�wb P c 61/It ec--„) Av.ao I - i Site Plan submitted by: SIGNATURE Plan Approved ' I Not Approved By o- L I CHA GES MUST BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT FIRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used) (Stock Number. 5744 - 002 - 4015 -6) TITLE Date , ' 7 County Public Unit Page 2 of 3 F. r - 2/ 1 . 2 Date I I q Job Address Legal Description Owner / Lessee / Tenant Owner's Address JP) PERMIT APPLICATION FOR MIAMI SHORES VILLAGE (q r 1 N p e es S DO Phone / D Address (Q() f L( S /Lit, /(fir /q!t Qualifier wdL/19/ T . 144er SS4# "/ - � Phone 3oS- 65 ~‘?z31 State #CFC0 D7?_ Municipal # Competency # Ins.Co. Architect /Engineer Address Bonding Company Address Mortgagor Address Permit Type(circle one): BUILDING ELECTRICAL PLUMBIN MECHANICAL ROOFING PAVING FENCE SIGN WORK DESCRIPTION l /r�.►.J , e4 Square Ft. Estimated Cost(value ( ,c'o ar 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 the work stated. ractor or Owner- Builder Notar as to ContrFw or Owner- Builder My Commission Exp :< . Marlin K Coh My Commission CC60b1b Expires November 21 2000 �k. =1 * ** * * * * * * * * * * * * tt4 * * ** FEES: PERMIT 3C RADON C.C.F. .Co NOTARY TOTAL DUE Other Electrical Engineering LOT: PROPERTY ID #: {q 44 [Sect Town9hip /,RangejParcel No. •or3ax D Nuunber] TO BE COMPLETEilkBsZ EN60E10EA)vTti UNIT EMFOtoYEE;' OR OTHEk PERSON. ) 1kGINEEIeS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [Lei [ J NO NET USABLE AREA AVAILABLE: IZ 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: NV SQFT UNOBSTRUCTED AREA REQUIRED: SQFT BENCHMARK /REFERENCE POINT LOCATION: S E CU. . c?= ✓) PE IM S / ELEVATION OF PROPOSED SYSTEM SITE IS rINCHES /FT4 [ABOVE /BELOW] BENCHMARK /REFERENCE POINT THE MINIMUM SETBACK N W ^ HICH SURFACE WATER: --f' FT WELLS: PUBLIC: hJ FT BUILDING FOUNDATIONS: SITE SUBJECT TO FREQUENT FLOODING: [ ] YES c4 NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: IC),3 \ FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1 Munsell # /Color Texture USDA SOIL SERIES: Depth C) to to to to to to to to OBSERVED WATER TABLE: h'' INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT] ESTIMATED WET SEASON WATER TABLE ELEVATION: V\- INCHES [ ABOVE / BELOW ] EXISTING GRADE. HIGH WATER TABLE VEGETATION: [ ] YES _[i] NO MOTTLING: •( ] YES [....J--NO DEPTH: ,------- 11 SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [ ] TRENCH' [ /"j BED [ ] OTHER (SPECIFY) REMARKS /ADDITIONAL CRITERIA: e' r SITE EVALUATED BY: HRS -H Form 4015, Mar 92 (Obs s previou - •itions which may not be used) (Stock Number: 5744 - 003 -401 STATE OF FLORIDA " PERMIT I 7R 27 DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS BLOCK: SUBDIVISION.: � � ► IN \ t ( L)c -. CAN BE MAINTAINED FRO DITCHES /SW ES: LIMITED USE: FT IS FT PROPERTY LINES: AGENT: A A LL 144E ! � POSED SYSTEM TO THE FOLLOWING FEATURES: FT NORMALLY WET? [ ] YES [->� NO PRIVATE: FT NON- POTABLE:Yv� V FT I5 FT POTABLE WATER LINES: (01- FT 10 YEAR FLOODING? [ ] YES [X_ NO SOIL PROFILE INFORMATION SITE 2 Munsell # /Color Texture Depth IBIvlLvC cti \ L O to f 1 to b ' �r- to to to • to to to to USDA SOIL SERIES: J DATE: 7.7 Page 3 of 3 INSTRUCTIONS: PERMIT 0: Perri r, ' :!�;.g rite. ^� .. asi gnerl by CPItU. APPLICANT: P'operty owner:. `uil now.. AGENT: Piuperty o ^r;•vr' ;eli �' :: ,14rorze7 e:nrs _:.: u<, . LOT, BLOCK, SUBDIVISION: • Lit. Toss, and .,i.bdivi: for lot. PROPERTY ID//: 27 character n:err ∎)er for property. (property appraiser E: 3 c:r aurr:ber) PROPERTY SIZE: Check if property size at ai , cm grits to eubsitted site plan.:ieco: act us =:iula area avr.:lab'.e -1'7;1 area euclse ve of all paved areas aid repared road Leda within 7ablic sighs -of way or east:merit; and estetueat"c cY ci,r. nina, lakes, • normally wet drainage ditches, marshes, or other such bodies of water. SEWAGE FLOW: UNOBSTRUCTED AREA: MINIMUM SETBACKS: Record the estimated sewage flow for the establishment from Table (residence3) 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 gallon per day per acre For private water supplies and 2500 gpd per acre for public water supplies). If authorized sawage flaw 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. Record minimum setbacks which can be meet to all listed features. Actual measurements must be recorded or 'NA" for non applicable 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 for 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 documentation submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 SITE 2 SITE 3 [ +) SHOT: H.I. H.I. - - H.I. WI. H SHOT [ -) SHOT - . [ -) SHOT BUILDING ❑ ELECTRICAL ❑ PLUMBING PERMIT N? ROOFING ❑ Owner of ,�' Building '3 Architect • Contractor or Builder 8 ' i; Legal Lot Description I I B1 Address ofd ..:.R Building / 7 1 +® d` '' .t CONTRACTOR or BUILDER MIAMI SHORES VILLAGE, FLORIDA 9682 Date — f Isar Contractor's License No. Subdi- vision Sq Ft Value of I I Amount of Project $ I I Permit $ BY AUTHORITY C2 93 Work to be performed under this Permit 0 This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the applica- tion herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any 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 knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes respon- sibility for work done by his agents, servants or employees. C fi Signed' /? / / (INSPECTOR) RV In consideration of the issuance to me of this permit agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, awings, 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, illy agent, servant or employee. i s:� Permit No ..... 1��!_ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of th4 Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address. V_S_ s No.__—____/-_7._ -/ _____ _____ Street _!Y._ - . 6 0 _, v7 Registered Architect and /or En ineer ... . Employing Plumber's Name i. J_ _._z. 'h tr— cc — x_c_ isio._ 7,s._ Street.4 STS Location and Legal Description Lot_ ___..... _.— __.___._ __ —._. _. _ Block_ Street and Number where work is to be performed —No New Building __._ Remodeling Size Septic Tank Feet of Drain Tile _. Nature of Water Supply: City —Well. - - - -- - -- - - ;) Amount of Permit $ v STATE OF FLORIDA, t COUNTY OF DADE. as. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 11' _. = / 5 , State work to be performed and purpose of building (By Floors)____. LPi_. #y -. _ 02/_ai eF.1_40 .. _ ZS _ LQ i' Street Date _ -_ i Subdivision Addition____ _ Repairs. .1/ -__ No. of Stories _ Type of Tank ___Dist. Feet of Tank or Drain Field from Well _._ Size of Soakage Pit Capacity Gals. .. Plumbing In:pecto. The undersigned applicant for this building permit does hereby certify that he understands and acce is obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor - ed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the wo such p , is notice or no'ices as are required by the Act. The undersigned agrees to employ only such sub- contra work to .e perfo .:ed under this per nit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personall • appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the _. _... __ ....._ of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all 'acts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and/or worlananship. Y CLOSETS BATH TUBS OW SHOWERS LAVA- TORIES SINKS SLOP SINKS LAUNDRY TUBE URINALS CATCH BASIN FLOOR DRAIN DRINKING FOUNT' NS TOTAL FIXTURES CONTR. LIST CHECK SEPTIC TANK SEWER CONN. DRAIN FIELD SOAKAGE PIT GREASE TRAP SOLAR H EATER DEEP WELL SPRKLR. SYSTEM SWIM'G POOL CONTR. LIST CHICK Permit No ..... 1��!_ Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores Village Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regulations of th4 Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans and specifications must be kept at building during progress of work. Owner's Name and Address. V_S_ s No.__—____/-_7._ -/ _____ _____ Street _!Y._ - . 6 0 _, v7 Registered Architect and /or En ineer ... . Employing Plumber's Name i. J_ _._z. 'h tr— cc — x_c_ isio._ 7,s._ Street.4 STS Location and Legal Description Lot_ ___..... _.— __.___._ __ —._. _. _ Block_ Street and Number where work is to be performed —No New Building __._ Remodeling Size Septic Tank Feet of Drain Tile _. Nature of Water Supply: City —Well. - - - -- - -- - - ;) Amount of Permit $ v STATE OF FLORIDA, t COUNTY OF DADE. as. MIAMI SHORES VILLAGE PLUMBING INSPECTION DEPARTMENT APPLICATION FOR PLUMBING PERMIT 11' _. = / 5 , State work to be performed and purpose of building (By Floors)____. LPi_. #y -. _ 02/_ai eF.1_40 .. _ ZS _ LQ i' Street Date _ -_ i Subdivision Addition____ _ Repairs. .1/ -__ No. of Stories _ Type of Tank ___Dist. Feet of Tank or Drain Field from Well _._ Size of Soakage Pit Capacity Gals. .. Plumbing In:pecto. The undersigned applicant for this building permit does hereby certify that he understands and acce is obligations as an employer of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida Permanent Supplement, and has com- plied with the provisions thereof, and will require similar compliance from all contractors or sub - contractor - ed by him in the work to be performed under this permit; and will post or cause to be posted' for inspection on the site of the wo such p , is notice or no'ices as are required by the Act. The undersigned agrees to employ only such sub- contra work to .e perfo .:ed under this per nit, as are licensed by Miami Shores Village. Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personall • appeared to me well known, and who, being by me first duly sworn, upon oath deposes and says that he is the _. _... __ ....._ of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all 'acts therein by him stated are true. My Commission Expires Notary Public, State of Florida NOTE: A re- inspection fee of $1.00 will be made when such re- inspection is made necessary by improper notice for inspection, or faulty materials and/or worlananship. Y