253 NE 100 St (6)Date R/ 2.21/ S Job Address a .- 3 Jy 6 l oa 5/r-. Tax Folio
Legal Description A i 8 / 191, 3 f My y IoF2f Historically Designated: Yes
/ Tenant ,' Ii PreLe9-
Z E Awe, S fir • Phone
Owner's Address
Contracting Co.
Qualifier
State # Municipal # Competency # Ins. Co.
1 Architect/Engineer
Bonding Company
Mortgagor
Permit Type (circle one): BUILDING ELECTRICAL
e
WORK DESCRIPTION
Signature of owner and/or Condo President
as t Own and/or Condo President
y Commission Expires:
1Al. NOTA: f SEA
GALE E' :J't.'.:LL
NOTARY MIMIC. Cs `LOniDA�
�c�Ci.. ,.;,�. CC-233955 G7,.9RI:.,
MY COMMIS: ;!ON ESP. DEC. 51997
FEES: PERMIT 3 r--62) RADON
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
/ / �S
Date
APPROVED:
Zoning Building
Mechanical Plumbing
Address
Address
Address
LUMBING ECHANICAL ROOFING PAVING FENCE SIGN
Date
C.C.F.
Address
/
32/4 0! 3 2//19®
Master Permit #
77.—c9
SS#
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.
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 Contractor or Owner- Builder
Notary as to Contractor or Owner- Builder Date
My Co
lint
jx P OFFICIAL NOTARY SEAL
O <� SANDRA PA MONTIEL
lii� n COMMISSION NUMBER
Na, CC401261
FA Ti ci",' WV COMMISSION , EXP.
Or F\d AUG. 17 1698
NOTARY . TOTAL DUE
Electrical
No O-
3g
Date
q)
Engineering
APPLICATION FOR:
[ ] New System [ ] Existing System [ ] Holding Tank [ ] Temporary /Experimental
[ A Repair [ ] Abandonment [ ] Other(Specify)
e
APPLICANT: /.A / 1) r €
AGENT:
MAILING ADDRESS: � s 3 iL`f ��� S��
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND TO -SCALE
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
PROPERTY INFORMATION [IF LOT IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTIO13.OR DEED)
LOT:
PROPERTY ID #:
PROPERTY SIZE:
PROPERTY STREET ADDRESS:
DIRECTIONS TO PROPERTY:
BUILDING INFORMATION
Unit Type of
No Establishment
2
3
4
BLOCK:
APPLICANT'S SIGNATURE:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chapter 1OD -6, FAC
[ ] Garbage Grinders /Disposals
[ J Ultra -low Volume Flush Toilets
SUBDIVISION:
HRS -H Form 4015, Mar 92 (Obsoletes previous editions
(Stock Number: 5744- 001 - 4015 -1)
DATE OF
SUBDIVISION
[Section /Township /Range /Parcel No.] ZONING:
ACRES [Sqft/43560] PROPERTY WATER SUPPLY: [ ] PRIVATE (4„4
pl - 33/
[ ] RESIDENTIAL [ ] COMMERCIAL
No. of Building # Persons Business Activity
Bedrooms Area Sqft Served
] Spas /Hot Tubs
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
TELEPHONE: 7
DATE:
s�- 6777
For Commercial Only
[ ] Floor /Equipment Drains
] Other (Specify)
ch may not be used) Page 1 of 3
APPLICANT:
LOT:
t
PROPERTY ID #:
0
T
H
E
R
SPECIFICATIONS BY:
APPROVED BY:
DATE ISSUED:
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND
ONSITE SEWAGE DISPOSAL S
CONSTRUCTION PERMIT
Authority: Chapter 381,
BLOCK: /-, SUBDIVISION:
HRS -H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number: 5744-002-4015-6)
PERMIT # ?,5 /e- - cab7/
REHABILITATIVE SERVICES DATE PAID 7- 9q*-5k5
YSTEM FEE PAID $ ••/#<0.
RECEIPT # V®
FS & Chapter 1OD -6, FAC
CONSTRUCTION PERMIT FOR:
[ ] New System [ 4 Existing System [ 4 Holding Tank [ / J Temporary /Experimental
[ \T] Repair v.4] Abandonment [".4 Other(Specify) / �� GE �����
AG NT:�y, 9T�r!
Z cc4 7 ,D-JJ /Jg29
PROPERTY STREET ADDRESS: e A
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS ANDISTANDARDS OF CHAPTER 1OD -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 'SPEpLFI ATIONS
T [ 7)] [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 "' SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ) SQUARE FEET SYSTEM
A TYPE SYSTEM: [K] STANDARD [hi] FILLED [ MOUND [ ]
I CONFIGURATION: [64] TRENCH [ ] BED [
N
F LOCATION OF BENCHMARK: c.4 P ti d" G'i ;77 "1'? - 7, 1: C / eK1'ii
I ELEVATION OF PROPOSED SF YSTEM SITE [ 4 4. [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ ,,/ ,hl [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
L �!
D FILL REQUIRED: [ /J / INCHES
HRS-H Form 4016, Mar 92 (Obsoletes previous editions which may not be used)
(Stock Number: 5744 - 001- 4016 -0)
APPLICANT
[SECTION /TOWNSHIP /RANGE /PARCEL NUMBER]
[OR TAX ID NUMBER]
EXCAVATION REQUIRED: [ 4-ir INCHES
,117Z1.1.., '7 ( -- lr' �� .�..�-.... _
�,. r
TITLE: € »e
TITLE:
EXPIRATION DATE:
CPHU
Page 1 of 2
Page 2 of 3
1,
A OF HEALTH AND REHABILITATIVE SERVICES
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE,RMIT
Permit Application Number
HRS-H Form 4015, Feb 85 (Obsoletes previous editions which may not be used)
(Stock Number. 5744-002-4015-6)
STATE OF FLORIDA
. I I
' • I , • I •
' • ' ; I 0
11-
PART II - SITE PLAN
qo
(14c.,,
r
A rr e/a 6 - 0 - 1 /- 44.
■.■
' , , ' .:. .. , t 1 • .1 _L_LI
klitij .
I , .
, ■ rii..I Hi, .;
.1 'i• ' ! :.1i.i111 ! 1'. :!`i 'LLI ;II 11 ,
1 , , , ; . . . , ; ■ ; II, ;1 ;1; ■ : .•
1 --
; .
1 :
1 1 L 1
1 1 1.1 1 1 I 1! .111 u '1 ': I I 1 1 1 1 1 1 1 ! 1
; ; ;
i ..._ 4 _ -4--4-+- .4_ ___. • 1 ..,, 4. ., . J., ; 4._ -',.. 1-,,,i-Tt 44-....,-...4_,I__,..2,......L_1-1:„....-4- 4._1_ ..... 1 I - 1 1._
1 1
! t 1 t • 1 t r , ■ 1 1 : 1 I I ' 11 1 I . ^" I U
, 1 III •__J 1 11 III .1,..„1 HI 1 1 . , .....1_1J 0 hi
111 , t • , . i 1
1 ••1 • 1•• it 11,11 ittittifiL:11t.t11 I,
' ' (
1 t t I 1 r- "' • ' j . ' ' ' ; ' ; ' ; 1 1 l'I 111 lir HI II 1
1 !I 1 1 1 II; .. -- 1 1 tt
t ; t ,t; tt_tt' t • , t .04
I . 1 I . 1 1 I : I 1 1
1 t 1T-1 1-) I 1 , Ht 1 , t t t i t F
i it 11111 . , ■ I 1 'I 11111' I 1 1.111111
'II ,, 11 III 1 1_1111 11 , '1,0_111 ' IIIIIJI III I 'll; 1 , , H.111_11
11
Notes r-4--f (-t-, -, ,.....„ , ,i, • • . ..
. /
I 0‘.: / 11 /
. r,r....-
Site Plan Submitted by
Plan Approved / Not Ai5Froved
4
By
ALL CHANGES MU T BE APPROVED BY THE COUNTY PUBLIC HEALTH UNIT
LL0
7
r 3 )
TITLE
Date
County Public Unit
Page 2 of 3
APPLICANT: � //J K i �� a AGENT: /J r r�,, /494)6/_,
LOT: ej Jo_ - BLOCK: gl SUBDIVISION: J �j-
/
PROPERTY ID #: I /
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 ( ]
TOTAL ESTIMATED SEWAGE FLOW: a ; GALLONS
AUTHORIZED SEWAGE FLOW: -- J. ?GALLONS
UNOBSTRUCTED AREA AVAILABLE: / 5 (p !9 SQFT
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] [ABOVE /BELOW] BENCHMARK /REFERENCE POINT
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE
SURFACE WATER: 4/,a FT DITCHES /SWALES:
WE LLS: PUB LIC: l FT LIMITED USE: FT
BU ILDING F OUNDATIONS: / S FT PROPERTY LINES:
SITE SUBJECT TO FREQUENT FLOODING: [ '] YES Imil_ NO
10 YEAR FLOOD ELEVATION FOR SITE: 4 -0 MS /NGVD
SOIL PROFILE INFORMATION SITE 1
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
Munsell # /Color Texture Depth
4% P c7 to
pr y / /!,, n> e
c / to
to
to
to
to
to
to
to
USDA SOIL SERIES:
OBSERVED WATER TABLE: 2 INCHES [ABOVE / BELOW] EXISTING GRADE. TYPE: [PERCHED / APPARENT]
ESTIMATED WET SEASON WATER TABLE ELEVATION: / • INCHES [ ABOVE / BELOW ] EXISTING GRADE.
HIGH WATER TABLE VEGETATION: [ ] YES (/ij NO MOTTLING: ( ] YES [ NO DEPTH: INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING•
DRAINFIELD CONFIGURATION: [ ] TRENCH (, ] BED
REMARKS /ADDITIONAL CRITERIA:
! -( 0
SOIL PROFILE INFORMATION SITE 2
SITE EVALUATED BY • ; -4?
HRS -H Form 4015, Mar 92 (Obsoletes previous bu s which may not be used)
(Stock Number: 5744 - 003 - 4015 -1)
[Section /Township /Range /Parcel No. or Tax ID Number]
NO NET USABLE AREA AVAILABLE: , ORES
PER DAY [RESIDENCES -TABLE 1 / OTHER-TABLE 2]
PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
UNOBSTRUCTED AREA REQUIRED: ; SQFT
Munsell # /Color Texture
iWcee4 /Qr1'/ /J i r/.
r-17 5fliti i7
Depth
/'to /
/ to G/ /
to 4
to
to
to
to
to
to
USDA SOIL SERIES:
PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
FT NORMALLY WET? [ ] YES rt1 NO
PRIVATE: FT NON - POTABLE: T
4142 FT POTABLE WATER LINES: ` FT
10 YEAR FLOODING ? [ ] YES ell_ NO
SITE ELEVATION: G ! I FT MSL /NGVD
r A J
DEPTH OF EXCAVATION:
OTHER (SPECIFY)
PERMIT # %!(
DATE: 7
Page 3 of 3