321 NE 100 St (9)Date Time
Type Insp'n
Permit No.
Name
Address
Company
Phone #
For Inspector:,
Approve`
Correction
Re- Insp'n Fee
MIAMI SHORES VILLAGE
BUILDING DEPART NT
305- 795 -2204
Building Inspection Req
Name & Date
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Bulding Inspection Requ-
Dat
- l7
Type Insp'n '
Permit No. T..) Q In\- 13 �O 3
Name
Address .3 0 c 1 ' �'�/ V �/
1a
Company#
Phone # L ?v5 , e FS
For Inspector: g
Name & Date
Approved
Correction ❑
Re- Insp'n Fee ❑
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
_ k j Building Inspection Request
Dattei /3O /D�. Time
Type Insp'n
Permit No. P �" c2 0 0
Approved
Name ___"
Address 3 a [ 11 c 4 , ( Q j)(
CompanyQ,3*71 A
Phone # g C7 c, ‘9_C., b 7 ) ,
For Inspector: ( (3/0 A E Name & Date
Re- Insp'n e ❑
/ i1 �
c,),e
a �,
MIAMI SHORES VILLAGE
BUILDING DEPARTMENT
305- 795 -2204
Bu' ding Inspection Request
Date 9 a- Time
Type Insp'n f f flC4 I Euildin9
Permit No.. 94
Name Knot*
Address 321 NE IOOS
Company 04�l
r, U . [ Q 1 / r �
Phone # �(9 %S-O(1 1.D.,
Approved
Correction
Re- Insp'n Fee
For Inspector: bp 112,5 Name & Date
,„
3acr1
c,
DEPARTMENT OF PUBLIC HEALTH
Dear Mr. Well Driller:
DADE COUNTY
1350 N. W. FOURTEENTH STREET
MIAMI. FLORIDA 33125
Your application for drainage well at the address shown on the attached form
has been approved under the provisions stated on the form. Please notice that
the form you are receiving is in two parts; the upper being the drilling permit
and the lower one being a permit to operate drainage well. The provisions
stated on the drilling permit are intended to guide you in drilling the well
in accordance with the regulations of this office. The provisions stated on
the operating permit inform the owner of the purpose for which the well is
permitted, and of any special treatment which must be provided before waste can
be discharged into the drainage well.
After the well has been completed in accordance with the provisions of the
drilling permit, you should fill in the blank spaces on the operating permit
so that this form will show the actual diameter and depth of casing and the
actual depth to which the well is drilled instead of' the estimated diameter
and depths as given on the upper half of the form. The completed operating
permit form should then be detached and forwarded to the Dade County Depart-
ment of Public Health so that it maybe countersigned and mailed to the owner.
The drilling permit is for your files. Information copies of both the drill-
ing and operating permits have been furnished to the owner, to the State Boai'td
of Health and the State Geologist.
You are required to make a record of the log of the wells one copy of which
must be furnished to the State Geologist and the other copy to the Dade County
Department of Public Health. The State Geologist may also require that you
save cuttings from the well for his use.
You are requested to notify this office of any change from the provisions of
this permit prior to placing them into effect.
Very truly yours,
Robert L. wick, Director
Engineering Division
t §'y F s
RLQ :iw 3
Enclosures
cc: Owner w /enc.
cc: State Geologist w /enc.
CC: §441.114. 4141flOt Divitton
W. R. STINGER, M. D., M. P. H.
ACTING - DIRECTOR
TELEPHONE 377-0341
PERMIT TO DRILL
Issued to Pickers 1 s11 Drilling (Driller)
Misd, florid* (Address)
cause. 16th
Granted this
(Not valid until countersigned by a duly
DAVID B. LEE
Director, Bureau of Sanitary Engineering
By
FLORIDA STATE BOARD OF HEALTH
BUREAU OF SANITARY ENGINEERING
Jacksonville 1, Florida
DRAINAGE WELL
Dr, A. M. oo.t.ahius
321 It. E. I00 Street
Miami $Acres, h orida
For
13- 5759 -69
Permit No
(Owner)
(Address)
In accordance with the provisions of Chapter 381 and Chapter 387, Florida Statutes, together with
Chapter XXI, Florida ttik atil o itpa n � r gt rainage well at
Qgew
Proposed Diameter roposed Well Depth roposed Casing Depth
Inspection has been made of the site of proposed drainage well by a duly authorized representative of
the State Board of Health and permission is granted for drilling the well with the provision that
1. Log of moll to be submitted to the Bureau of Ssnitsry Eofiineering,
hlorida State Hoard of Health.
2. Drainage well to be located a minimum of 25' from septic tank and
drain field.
no case be placed in service until the attached permit to oper-
authorized representative of the State Board of Health, and
Upon its completion this well shall in
ate has been completed, signed by a duly
delivered to the Owner.
This permit is revokablelny time
Granted this
Issued by:
BUREAU OF SANITARY ENGINEERING
4! %G
D irector g
Director, Engineerin Section
Dads County HealtIFIlettiltrilla STATE BOARD O F HEALTH
BUREAU OF SANITARY ENGINEERING
Jacksonville 1, Florida
for failure to conth the provisions as stated herein. 69
day of , 19
Approved:
S ta t e Health Offic
Permit No 13- 5759 -69
PERMIT TO OPERATE DRAINAGE WELL
In accordance with the provisions of Chapter 381 and 387, Florida Statutes, together with Chapter
<CIAElgrljdcojointijaidi pry Code, permit is granted 321 14. E. 100 Street, Miami Strorea Za.
1 ((iry t •
ddress)
to operate a drainage well located at
Subject to the following provisos:
3. Well is to be used for disposal of waste rater from closed system
air conditioning unit only.
This drainage well is inches in diameter, feet deep, cased to a depth of
feet, drilled by
(Name of Driller) (Address of Driller)
This permit is revokable at any time for failure to comply with the provisions stated herein, or if this
drainage well should at any time contaminate or otherwise affect other waters in the vicinity, or for other
day of April , 19 b9
authorized representative of the Florida State Board of Health.)
Approved:
WILSON T. SOWDER, M.D.