1470 NE 101 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 7/2.-/X Job Address / Y" 2 G /V 0 / 57
Tax Folio /1 7 z.o,- 019 -0-0-60
Legal Description L a f /U / �- f Historically Designated:
Owner/Lessee / Tenant 5 te,,Z e ' - R {j /2/ 4 /(:v`r/7Zy
Owner's Address / r 7 D /1/ ' / G / S Phone 7 ( — 75/2
Contracting Co.
Qualifier
State # S FP , 9 072 ZMunicipal #
/cG
Competency #
Yes No
Master Permit #
Lf
Address 7 7o / iv t/ / /q /7/
SS# - Phone 7'l 2 cf=Za'
Ins. Co.
Architect/Engineer Address
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRIC _
WORK DESCRIPTION / /
Square Ft. 7 G 6
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 zo • Furthermore, uthorize the above -named contractor to do the work stated.
l 1 i 1 1 1 1
lk M1L �'QIR U 0i
�IIC� No. CC 9262
1 1 PalimaW Krown 1 1
d/or Condo President
Signature
1 .'+' 1 :
My Co
FEES: PERMIT RADON
APPROVED:
Zoning Building
Mechanical Plumbing
o? S Vv/ � ?PTO
Date
Date
aa
C.C.F.
PLUMBING
Address
MECHANICAL ROOFING PAVING FENCE SIGN
Estimated Cost (value) / ,-O O
Signature of Contractor
otary as to Con for or Owner -Bui11 y . -- Date
OFFICIAL NOTARY SEAL
P Pi, E MARGARITA 1AONT1EL
0 ~ ( My� 1 �0 co o$ NUMBER
4('' } F Q CC797277
F' � O !�Y COmmiSSION EXPIRES
9f6 O N DEC. 17,2002
My Commissi
.
,r
/- NOTARY
! . 1_
Electrical
7 Lfl Gc
er- Builder ate
BOND
36
TOTAL DUE 3..7 6 O
Structural Engineer
APPLICANT:
LOT:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE.SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
/ e A e /!e I G: A AGENT:
/ ,lam
BLOCK: SUBDIVISION: p / 4 i , /'Cfr J & c5 (
PROPERTY ID #: // -) a z 9 <• G (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: [
TOTAL ESTIMATED SEWAGE. FLOW: 70 0
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF, PROPOSED SYSTEM SITE IS
THE MINIMUM SETBACK WHICH
SURFACE WATER: /i,^6". FT
WELLS:`PUBLIC: 4% FT
BUILDING FOUNDATIONS:
10 YEAR FLOODING? [ ] YES g./rNO
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION:. / FT MSL /NGVD
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [(/J'NO
•
SOIL PROFILE INFORMATION SITE 1 ' 3', S -
Munsell Co or
JM
TN/
G Vl
USDA SOIL SERIES:
Texture
SO H
oiy
Depth
O to
to72.
to
to
to
$ r ' /7_ to
to
to
t
SITE EVALUATED BY:
INCHES [ABOVE / BE
OBSERVED WATER TABLE:
ESTIMATED WET SEASON WATER TABLE ELEVATION:
HIGH WATER TABLE VEGETATION: [ ] YES [LNO
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 3] which may be used)
(Stock Number: 5744- 003 - 4015 -1)
PERMIT #
OYES [ ] NO NET USABLE AREA AVAILABLE: l/i Z 2 • ACRES
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2] ,,.
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /ACRE]
SQFT UNOBSTRUCTED AREA REQUIRED: G6 Q SQFT ,
;p7/4;0,-Cte
• ( INCHES /FT] 'A BOVE/ BELOW ]0BENCHMARK /REFERENCE:.POINT
CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES:
DITCHES /SWALES: /i t FT NORMALLY WET? V YES [ ]'NO
LIMITED USE: � FT PRIVATE: FT NON - POTABLE: FT
FT PROPERTY LINES: 3' FT POTABLE WATER LINES: 2 a FT
SOIL PROFILE INFORMATION SITE 2
� ] EXISTING GRADE. TYPE• EERCHED / APPARENT]
IN
'2 CH S[ABOVE Q W , ] EXISTING GRADE.
MOTTLING:.[ ] YES [ NO DEPTH: INCHES
DEPTH OF EXCAVATION � 2— INCHES
OTHER (SPECIFY)
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: ;/' /r V
DRAINFIELD CONFIGURATION:' [ ] TRENCH ['�] BED [
REMARKS /ADDITIONAL CRITERIA:
DATE: /6
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 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.
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 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 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 [ - J SHOT [ - ]SHOT
O
T
E
R
SPECIFICATIONS BY:
o .
DATE ISSUED: 7-- / 3 , - - Ci'J
DH 4016, 12/99 (Page 1) (Previous
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM
CONSTRUCTION PERMIT
CONFTRUCTION PERMIT FOR,
[V] New System 0 Existing System
of] ] Repair [P'] Abandonment
APPLICANT: 'f � ', h-` " e7 A
PROPERTY ADDRESS:
D
R
A
I /
F LOCATION OF . BENCHMARK: G i v A i ‘
I ELEVATION OF PROPOSED SYSTEM SITE [
E BOTTOM OF DRAINFIELD TO BE [L./( 8]
L
D FILL REQUIRED: [ ] INCHES EXCAVAT
APPROVED BY:
`T
Editions May Be Used)
pt. 1: Health Department
pt. 2: Applicant
pt. 3: Installer /Contractor
pt. 4: Building Department
PERMIT NO. �.
DATE PAID: 7_
FEE PAID:
RECEIPT #:
[ Holding Tank [ /]` Innovative
[/t( Temporary [ ]
LOT: BLOCK: f SUBDIVISION:
p o [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY . ID #: t 1 2 � [OR TAX ID NUMBER]
SYSTEM MUST BE. CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065,
F.S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SAFTISFACTORY
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. ISSUANCE OF THIS PERMIT
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING
REQUIRED.FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS
T (f' S GALLONS / GPD TAN /AEROBIC UNIT CAPACITY MULTI- CHAMBERED /IN- SERIES [ ].
A [ ] GALLONS / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ]
N [
K [
] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
] GALLONS DOSING TANK CAPACITY [ ]GALLONS @ [ ] DOSES PER 24 HRS # PUMPS [ ]
[445D ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
[ ] SQUARE FEET SYSTEM
TYPE SYSTEM: [ ] STANARD [ ] FILLED [ ] MOUND [ ] _
CONFIGURATION: [ ] TRENCH [t.-] BED [ ]
F +?.ir tq " G ,;C1 (t) , P', S . /) 1 f'1 r Ps /f S ff G,)
S /FT] [ABOVE /BEL.O_W] BENCHMARK /REFERENCE _POINT
[I FT] [ABOVE E�11 q BENCHMAR 'REFERENCE POINT
ION REQUIRED: [ 3-L■r INCHES
T r- °t;ra c ' 1 Byres R �.lL)
7, r ::,q r^I I,
TITLE':
.'. t.' it Lb1M VSi tIMO UVI
i5
EXPIRATION DATE:
/ / )c - CHD
3- i 1
Page 1 of 3
INSTRUCTIONS:
PERMIT NUMBER: Permit tracking number assigned by CPHU.
CONSTRUCTION
PERMIT FOR: Check type of permit, if "Other" specify type in blank.
APPLICANT: Property owner's full name.
SYSTEM DESIGN AND
SPECIFICATIONS:
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
I'ROPERTY ID #: 27 character id number for property. (CHD may require property appraiser ID # or section /township /range /parcel number)
TANK: Minimum specifications from Chapter 64E-6, FAC.
DRAINFIELD: Minimum specifications from Chapter 64E-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 (CHD) personnel reviewing and approving permit.
DATE ISSUED: Date permit is issued by CHD
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.
r_sc -
STATE OF FLORIDA PERMIT NO V 0 -
': / 2 ,
DEPARTMENT OF HEALTH DATE PAID 7
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM :PEE PAID:
CONSTRUCTION PERMIT R.ECEIPT #
COTRUCTION PERMIT FOp 1
[P'] New System Existing System [■ ;[
[X] Repair [44 Abandonment VII Temporary * I.
APPLICANT: /-•A'e ri
•
PROPERTY ADDRESS: ( Ai /CY .11
LOT: BLOCK:
SUBDIVISION: 19,7 S'AftWES P.)/// )J 1,-47:
(SECTION, TOWNSHIP, RANGE, PARCEL NUMBER
PROPERTY ID #: 1/ - 02 O61 • [OR TAX NUMBER]
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.00C;:
F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEWDOES NOT GUARANTEE SAFTISFACTC
PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN'MATERIAL.FACTS, WHICH SERVED AS
BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE"THE.APPLICANT TO MODIFY THE PERMIT ApPLICATIO_
SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PUT;
DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH. OTHER.TEDERAL, STATE, OR LOCAL.PERMITTI.:
REQUIRED FOR DEVELOPMENT OF THIS PROPERTY.
SYSTEM DESIGN AND SPECIFICATIONS •
DATE ISSUED: 7 /3-
DH 4016, 12/99 (Page 1) (Previous Editions May Be Used)
pt. 1: Health Department .
pt. 2: Applicant
pt. 3: Installer/Contractor
pt. 4: Building Department
.- • • '
-
T [( GPDGEPTIC TANVAEROBIC UNIT CAPACITY • MULTI-CHAMBERED/IN-SERIES [
A [ ] GALLONS / GPD CAPACITY • MULTI-CHAMBERED/IN-SERIES
N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 C4t,..L1.011
K [ ] GALLONS DOSING,TANK CAPACITY [ ]GALLONS 40 [ ] DOSES PER 24 HRS # PUMPS I
07/ ANIL/ 0 r 4 e.Ve
D (4f52.) ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANARD [ ] FILLED [ ] MOUND [ ] _
I CONFIGURATION: [ ] TRENCH (4■1 BED • [ ]
N , ,
F LOCATION OF BENCHMARK : 4 7 ' 4 , A 0 12) Tbi- 0 F - 13crift,,..940)X, ( Per 44 J . ii /tee ivt, F1 T/1 ; 1 ,
I ELEVATION OF PROPOSED SYSTEM SITE [ 1 S/FT] [ABOVE/B ] BENCHMARX/REFERENCE_91
E BOTTOM OF DRAINFIELD TO BE [4,0 ,] T] [ABOVE ELOW] BENCHMAR<EilEITE Pci
L
D FILL REQUIRED: [ ] INCHES EXCAVATION REQUIRED: [ 3
• " 'I-
I/MIMI-L0F LOAMY COARSE SAW
LI:Va.:51 E01701.1 OF ORALIF1113
0
F1141111V • 4
E 657111:V! 0
• ." , ..,,4 MALL GE
AilD LONGER THAN (t{
SPECIFICATIONS BY: PLOPOHill tI DUN TREWCii
APPROVED BY: TITLE: 2 /
EXPIRATION DATE: 16.- /
Page 1 of 3
APPLICATION FOR:
[ ' /] New System [ Al] Existing System
Repair [ +J] Abandonment
APPLICANT:
AGENT:
MAILING ADDRESS:
PROPERTY INFORMATION [IF LOT
LOT: BLOCK:
PROPERTY ID #:
/ S 4
DIRECTIONS TO PROPERTY:
1
BUILDING
1
2
3
4
/v / O
1 6 / �?
Unit Type of
No Establishment
STATE OF FLORIDA
j,DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
APPLICATION FOR CONSTRUCTION PERMIT
Authority: Chapter 381, FS & Chap er 10D -6, FAC
4
PROPERTY SIZEirri Z !7 ACRES
PROPERTY STREET ADDRESS:
N
[Sqft/43560]
[ ] Garbage Grinders /Disposals
[ ] Ultra -low Volume Flush'Toilets
APPLICANT'S SIGNATURE,! ':
/
( 2 , 4 f
[V] RESIDENTIAL
No. of
Bedrooms
DH 4015, 10/96 (Replaces HRS -H Form 4015 [Page 1) which may be used)
(Stock Number: 5744- 001 - 4015 -1)
[ Holding Tank [ /(/ ] Temporary /Experim��nt:.l
[ Other(Specify)
/76 "1 i
SUBDIVISION:
/2 ' /
, e e
Building
Area Sgft
PERMIT #
DATE PAID
FEE PAID $
RECEIPT #
•
5 y ,
U(:
/ 44,4,44 , / 5 (
TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. ATTACH BUILDING PLAN AND `=G• -::CF.
SITE PLAN SHOWING PERTINENT FEATURES REQUIRED BY CHAPTER 10D -6, FLORIDA ADMINISTRATIVE CODE.
IS NOT IN A RECORDED SUBDIVISION, ATTACH LEGAL DESCRIPTION 4:.
rh « yP% Icj .
DATE OF / 21_
SUBDIVISION /
7 G6D (Section /Township /Range /Parcel No.] ZONING:
PROPERTY WATER SUPPLY: [ ] PRIVATE. • (:rJ' ) ?t)f,..};,
'? a ' P S •
E /&ism
] COMMERCIAL
# Persons Business Activity
Served For Commercial Only
•
] Floor /Equipment Dr.•ai
] Spas /Hot Tubs
]'Other (Specify)
Page
APPLICANT:
LOT:
/G
PROPERTY ID #:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE DISPOSAL SYSTEM
SITE EVALUATION AND SYSTEM SPECIFICATIONS
BLOCK:
tL�
/
TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S M,
PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
TO SITE PLAN: [,1" L�
PROPERTY SIZE CONFORMS 7(: TOTAL ESTIMATED SEWAGE FLOW: (.
AUTHORIZED SEWAGE FLOW:
UNOBSTRUCTED AREA AVAILABLE:
BENCHMARK /REFERENCE POINT LOCATION:
ELEVATION OF PROPOSED SYSTEM SITE IS [INCHES /FT] (ABOVE/ BELOW ],BENCHMARK /REFERENCE PO
THE MINIMUM SETBACK WHICH
SURFACE WATER: f G FT
WELLS:'PUBLIC: t/ FT
BUILDING FOUNDATIONS:
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [4.0 10 YEAR FLOODING? [ ] YES [;.]
FT MSI. /NGVD SITE ELEVATION: c �, G FT P'iE;',/t.
SOIL PROFILE INFORMATION SITE 2
10 YEAR FLOOD ELEVATION FOR SITE:
SOIL PROFILE INFORMATION SITE 1
Munsell /Co or
/e, !(f� � 1'
Text re
/1 ':" fir >
USDA SOIL SERIES:
Depth
e2 to
to/ 2
to
to
to
/ to
to 77
to
to
/)
OBSERVED WATER TABLE: // ?•f
INCHES [ABOVE / BEL ] EXISTING GRADE. TYPE: (I?ERCHED / JU'kLP.E
ESTIMATED WET SEASON WATER TABLE ELEVATION: 1 AD
.% CINCHES- - :115 . 1 . 4).W - ] ( EXISTING t: U :.
HIGH WATER TABLE VEGETATION: [ ] YES [ L]''NO MOT [ . ] YES [ NO 'DEPTH: _'- ( 1,12. SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: /I( 6 DEPTH OF EXCAVATION( c J '‘NC DRAINFIELD CONFIGURATION: [ ] TRENCH [10 BED [ ] OTHER (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
/
SITE EVALUATED BY :/ / 7 / : o
!•
DH 4015. 10/96 (Replaces MRS -H Form 4015 (Page 3] which may be used)
(Stock Number: 5744- 003 - 4015 -1)
AGENT
SUBDIVISION: v' S
r I )4Lr 1 6, y( � i Cpl /9 ,
[Section /Towu /Range /Parcel No. or Tax ID hiws,t
] A YES [ ] NO NET USABLE AREA AVAILABLE: Ci -= AC1
GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER-TABLE
GALLONS PER DAY [1500 GPD /ACRE OR 2500 GPD /hCt.Ei
SQFT UNOBSTRUCTED AREA REQUIRED: G
CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWIN FE :.J1tE
DITCHES /SWALES: �✓ G FT NORMALLY WET? (I YES ( )
LIMITED USE: PRIVATE: FT PRIVATE FT NON - POTABLE:
FT PROPERTY LINES: FT POTABLE WATER LINES:
Munsell 1/Co or
/, yll 5
go y ('•
• 4 =��
�f ,!
H �G rr � • r
PERMIT #
Textur9
De th
49 to
to
to
to
to
to
to_?
t;.
USDA SOIL SERIES: Lir %
DATE: % — •
Pa;.. w
;cale: Each block epresents 10 feet and 1 inch = 40 feet.
._
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STATE OF FLORIDA
•
DEPARTMENT OF HEALTH r '
APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permit Application Number ‘- -t ..
Notes:
r
C: 2
.
•,/
/ /
Site Plan submitted by: !--1---7----- •- ___•,,.-.,
,-- ------ ;-
Plan Approved Z :".— . 2,
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
- 7—
County Health
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT
-
Rags 2 o.
Permit No. 93
Owner's Name and Address
STATE OF FLORIDA,
COUNTY OF DADE.
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 the 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.
Registered Architect and /or Engineer___—__—_________
Employing Plumber's Name — __ -__ No. _____ ___ Street_ —_
Location and Legal Description Lot ------ _------ ____ -- Block _.__ ___ Subdivision_--- --__--
Street and Number where work is to be performed -No. 1 L i l o "1F1 g k,
State work to be performed and purpose of building (By Floors) _
New Building ____ Remodeling ___________ Addition_
Size Septic Tank
Feet of Drain Tile_ Nature of Water Supply: City-Well.
Amount of Permit $
_ 7f___3 of
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No._----- ..... _.__...... -____ Street -
_ —Dist Feet of Tank or Drain Field from Well
(Signed)-
Date 1 - a'____� -
Repairs No. of Stories
Type of Tank__ Capacity Gals.
_.Size of Soakage Pit
L
(Signed)._ —Y7
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his 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 - contractors employed 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 work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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 facts
thereitiby, him stated are true.
Notary Public, State of Florida
NOTE: re-inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials ar)d /or workmanship.
Master Plumber.
CLOSETS
BATH
TUBS
SHOWERS
LAVA-
TORIES
INK
SINKS
SLOP
SINKS
LAUNDRY
TUBS
U RINALS
CATCH
BASIN
FLOOR
DRAIN
DRINKING
FOUNT'NS
TOTAL
FIXTURES
CONTR.
LIST
CHECK
SEPTIC
TANK
SEWER
CONN.
DRAIN
FIELD
SOAKAGE
PIT
GREASE
TRAP
SOLAR
HEATER
DEEP
WELL
SPRKLR.
SYSTEM
SWIM•G
POOL
Comm.
LIST
CHECK
1
/ Q1)
Permit No. 93
Owner's Name and Address
STATE OF FLORIDA,
COUNTY OF DADE.
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 the 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.
Registered Architect and /or Engineer___—__—_________
Employing Plumber's Name — __ -__ No. _____ ___ Street_ —_
Location and Legal Description Lot ------ _------ ____ -- Block _.__ ___ Subdivision_--- --__--
Street and Number where work is to be performed -No. 1 L i l o "1F1 g k,
State work to be performed and purpose of building (By Floors) _
New Building ____ Remodeling ___________ Addition_
Size Septic Tank
Feet of Drain Tile_ Nature of Water Supply: City-Well.
Amount of Permit $
_ 7f___3 of
My Commission Expires
MIAMI SHORES VILLAGE
PLUMBING INSPECTION DEPARTMENT
APPLICATION FOR PLUMBING PERMIT
No._----- ..... _.__...... -____ Street -
_ —Dist Feet of Tank or Drain Field from Well
(Signed)-
Date 1 - a'____� -
Repairs No. of Stories
Type of Tank__ Capacity Gals.
_.Size of Soakage Pit
L
(Signed)._ —Y7
Plumbing Inspector.
The undersigned applicant for this building permit does hereby certify that he understands and accepts his 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 - contractors employed 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 work such public notice or notices as are
required by the Act. The undersigned agrees to employ only such sub- contractors, on work to be performed under this permit, as are
licensed by Miami Shores Village.
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally 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 facts
thereitiby, him stated are true.
Notary Public, State of Florida
NOTE: re-inspection fee of $1.00 will be made when such re- inspection is made•necessary by improper notice for inspection, or faulty
materials ar)d /or workmanship.
Master Plumber.