PT-03-474 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 109636 Permit Number: PT -3 -09 -474
Scheduled Inspection Date: August 19, 2009 Permit Type: Paint
inspector: Bruhn, Norman
Inspection Type: Final
Owner: LUC, MARCEL Work Classification: New
Job Address: 141 NW 100 Street
Miami Shores, FL Phone Number
Parcel Number 113101022033
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
PAINT EXTERIOR OF THE HOUSE
Inspector Comments
Passed
Failed AN 2 0 Ea
.Correction a
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
A.. .a. , Q Anna For Inspections please call: (305)762 -4949 D a of 7n
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 109636 Permit Number: PT -3 -09 -474
Scheduled Inspection Date: August 19, 2009 Permit Type: Paint
Inspector: Bruhn, Norman
Inspection Type: Final
Owner: LUC, MARCEL Work Classification: New
Job Address: 141 NW 100 Street
Miami Shores, FL
Phone Number
Parcel Number 113101022033
Project: <NONE>
Contractor: HOME OWNER
Building Department Comments
PAINT EXTERIOR OF THE HOUSE
Inspector Comments
Passed El
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Asa„„- +,n '7nno For Inspections please call: (305)762 -4949 Dom. ^ ..s ,7n
r
J
Arm
0 4
Miami Shores Villagek.
Building Department
10050 NE 2 Ave
Miami., F133138
(305)795 -2204 (ph); (305)756 -8972 (fax)
ATTENTION
YOUR PAINTING PERMIT REQUIRES A FINAL INSPECTION
FROM THE BUILDING DEPARTMENT.
This permit is valid for 180 days. If it is not finalized during this period of
time, the permit will expire, and it will require payment of a renewal fee to
reinstate it and to be able to call final inspection to close the permit.
PLEASE, WHEN FINISH YOUR PAINTING; CALL THE BUILDING
DEPARTMENT AT 305 - 795 -2204 TO SCHEDULE YOUR FINAL
INSPECTION IN ORDER TO CLOSE YOUR PERMIT.
k-",LA� ,
wner or contractor's signature
Thank you for your cooperation
,-~
49 .74
Miami Shores Village
/
s
1
0050
N.E. � 2nd
Avenue
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Miami Shores •
s FL
331
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Ex i
tion: 09/ 2212009
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Project Address Parcel Number Applicant
141 100 Street 1131010220330
:
Miami Shores, FL Block: Lot: MARCEL LUC
... ...... ,., ............ - rrrrr.:o >ncw - ✓ •:•.v.:
f.
- ......:.•� ....>::.f................ae ' vf,....:... >. ::...•:::A•>ee ::::.:.:;• i�: r<..:.;:::. r.'•. �i�� ?x.:..: »..>: » ».;>...>:: >,... .. ..:..:........ : ».,:,::..•.'>>", ._ . w °c,�eS...... - - -v >.t:
Owner Information Address
_... . .,,..... .,....
......... .......,, one Cell
MARCEL LUC 141 NW 100 ST
MIAMI SHORES FL 33150 -1205
.•.:......... v.:...... n.•......... v.. vuw::.:. ....vvvv:...u..e.6a:Pu:Y:v ... : :..•..;.....C.n:.uv <....vf ..s en....•> ................ .• .
Contractor(s) Phone Cell Phone :::...,.. ... : :....:: :..._.__........... 1,000.00 .:.......
HOMEOWNER € Valuation:
;•<
Total Sq Feet: 0
Type of Work: Exterior Available Inspections:
Color:
Additional Info:
Inspection Type:
Classification: Residential
Final
Color: _Approved Code Comments: GLIDDEN - WALLS, CHIMNEY - I
Color: _Approved_
Fees Due AAn Invoice # Total Amt Paid Amt Due
CCF PT- 3-09-34348 $ 67.30 $ 67.30
Education Surcharge $ 0.00
Notary Fee Permit Fe e Technology Fee Total:
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining
thereto and in strict conformity with the plans, drawings, 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, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated.
March 26, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
March 26, 2009 1
-6XW VA Miami Shores- Village
Building Department l + 4 2009
1.0050 N.E.2nd Avenue. Miami Shores, Florida 33 p
Tel: (305) 795.2204 Fax: (305) 756.8972 BY ----- ------
-- -�. - --
BUILD ING Permit Iva.
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type PAINT PERMIT
Owner's Name (Fee Simple Titleholder) �(,(.�� Phone # 3 P
Owner's Address ( I_
City SltDres State j''� Zip 5BIJ6
Tenant /Lessee Name Phone #
E -MAIL:
Job Address (where the work is bein g done)
City �T Miami Shores Village County Miami -Dade Zip J AM
FOLIO / PARCEL # (/ J t p ®vii��
Is Building Historically Designated YES NO
Contractor's Company Name _ OC e Phone # � � t ►�
Contractor's Address
City___ State 5 Zip
Qualifier Name 'AIZ Phone # b 6
State Certificate or Registration No. Certificate of Competency No. IAI 1A,
OWNER BUILDER: Af_a 2U p Lv
Value of Work For this Permit $ 1 6 - 7- 4 S — Type of Work: ❑ Addition 1 ❑ Alteration 1 ❑New / Replace
Describe Work:
Application is hereby made to ollain a permit to do the work and installations m indicated. I certify that no work or installation has commenced prior to the ismance of a permit
and that all work will be performed to meet the standards ol'all laws ret construction in this jurisdiction. I understand that a separate perntit lnu0 be se4tte d tin' -
..
[ LECTRK.'Al. WORK. PLUMBING, SKINS, WELLS. "A.S. FIJRNACI:S, BOILERS. HEATERS, TANKS And AIR CONDITIONERS. LTC - -. l
- WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCp� iNT MAV UESILIL ' V4 , VOtlk IPAVING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONt3U(T WITii YCItIR'IE fI3' 111 t4AN ATIt t4tNEY BEFORE
RECORDING POUR NOTICE OF COMMENCEMENT."
Notice w :I ppl icant: :ts a condition to the iscrurnce of cr building permit with un estimated value excreding $ 3tN1. the applicant marst pmlMisc in gaeod.faith shat a CYq)j gf flu
notice of conune nceme nt and construction lien law brochure will be delivered to The person whose property is subject to attachment. Also, a certified copy gf the Pecxnrled notice
gfcommencemeni must be posted al the job site for lhe,irst inspection which occurs seven (?) days after the buildingpernift is issued In the absence of such lx Wed notice. the
inspection will not be approved and a reinspection fee will he charged.
�_ 5 PAID ******** * * *** * * * * * * * * * **** * * * * * * * * * * * ** Fees*** ������* �** �� * *��� *� * *�� *� *�� * *� *��� * *��
Permit Fee $ CCF $ Technology Fee:
Training /Education Fee $ Notary $ Code Enforcement S
Double Fee $ Zoning S Tel Fee Now Due $^
See Reverse side -�
PAINT COLOR APPROVAL AND AGREEMENT
All elements on the site must be listed and indicate the color to be painted
Directions: Please circle corresponding number to appropriate color sample.
Walls: ► ' 3 4 Attilch C010T saimptes with name and
rascia I 2 3 4 �iimber.
Drip Cap /Drip Edge: 1 2 3 4
SoffitI 3 4
Roos: I 3 4
Flower Bins: I 3 4 - f
I'
Dapper Tan • 10YY 55/163
Shutters: 1 2 4
Awnings: 1 2 3 4 2
Chimney: 1 2 4
Doors and Door ,lams: I 2 3 4
Garage Doors: 1 tt ,, 3 4
Railings: I 4 3
Fences: 1 4
All brick (simulated or regular 2 3 4
Stucco Banding: l 3 4
Any other Stucco Features: ( 4
Accessory Buildings Other:
OWNER'S AFFIDAVIT: 1 certify that all the foregoing fQ
§ Nation is accurate and that all work will be done in
compliance with all applicable laws regulating construction and '&i'ng.
Signatur Signature
Owner or Agent Contractor
The forego g in was ac kn ledgecl More e this U The foregoing instrument was acknowledged before me this
day oP ^!!✓�' 20(X day of' 20 �. by
who is personally known to me or who has produced who is personally known to me or who has produced
441 1
L• Rs identific,11 K and wl o did t ` & , Op`ti�1 as identification and who did take an oath.
NOT Y K 1 j U�fiy,�,; NOTARY PUBLIC:
Sign: ' 4 $ Sign:
Print: ' • Print:
My Commission [Npires: ��•' -: �'a�' My Commission Expires:
4 %all �
APPLICATION APPROVED BY: Plans Examiner
Preservation Board
Code Enforce rent
- (Revised 04 /24/01
PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
M 10050 N.E. 2nd Avenue - Miami Shores, Florida 33138.305- 795 -2204
{ Date I f ob ddress Tax Folio
Legal Description Historically Designated: Yes No
Owner/Lessee/Tenet Master Permit # ' L
Owner's Address Phone
Contracting Co. I.CO�Gfv Address
Qualifier o � SS# /�l*� �1
State # w� f/! Municipal # Competency # Ins. Co.
IF THERE IS NO PERMIT PACKAGE ACCESSIBLE ON THE JOB SITE FOR INSPECTORS TO VERIFY,
THERE WILL BE NO INSPECTION. RE- INSPECTION FEE IS $50.00 AND MUST BE PAID IN ADVANCE
BEFORE CALLING FOR ANOTHER INSPECTION.
Permit Type (circle on -BUI'LyDI�NG EL C PLUMBIN M�EC ROOFING
WORK DESCRIPTION: !�✓ /2:'�L� -J �y�ilrri
Square Ft. Estimated Cost (val
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MA RESULT IN
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR ANY 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 separat*�Vermits are required
for all disciplines.
OWNERS 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.
Z- Cq 11 z 6c)a94.-- &
Si na a of o ner and/or Condo President Date Si nature of Contractor or Owner Builder ate
g g
N er (j id nti) + Date Notary as t QI w 111 ate
M Exp *S .923, My Commi s ^n� :. 9,
{ } Pies* y Awm OOW 1.0, i�1 an r [ D 0#W iA.
FEES: PERMIT �. RADON C.C.F NOTARY '�- �.� BOND e:r
APPROVED: TOTAL DUE t
Zoning Building Electrical
Mechanical Plumbing _ Structural Engineer
r
rim
WALLACE PONDER 12 - 99 2097
D /B /A w P SEPTIC TANK CO.
305- 620 -8320
17235 N.W. 12 CT. .• j 1/ fY
f 83 271631 FL
MIAMI,
FL 33169 DATE T �_ � .. 994
PAY r t L
OR THE s �Q .� . ,
TOH
T OF E V
a�:;nj2d-�P&ZQ'e� ' �6 02 > DOL
Nat ionsBank
NationsBank, N.A.
ACH 083100277
FOR
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11 1:063 &00 27 ? 00366565935611'
ry
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Miami Shores Village .. g Permit �s�~
10050 NE 2nd Avenue P' m ,,.. p�»
.�
Phone: 305 - 795 -2204 Permit Number: PL2002 -193 `
l Printed: 7/29/2002 S Page 1 of 1
V
Applicant: CHRISTOPHER DAWES
Owner: DAWES CHRISTOPHER
L JOB ADDRESS: 117 NW 100 ST
J Contractor WALLACE PONDER SEPTIC Contractor's Address: 17235 NW 12 CT
+ 1 Local Phone: 305 -620 -8320
` Parcel # 1131010220310 Legal Description: 153 41 GOLD CREST PB 21 -56 W1/2 OF LOT 8 LOT 9 BLK 4 LOT
-. l Fees: Description Amount
.J FEE2002 -4174 Building Fee $80.00
FEE2002 -4175 CCF $1.80 Total Fees $381.80
v FEE2002 - 4176 Buildier's Bond $300.00 Total Receipts $381.80
Total Fees: $381.80
Permit Status: Approved Permit Expiration: 1/25/2003 Construction Value: $2,450.00
Work: INSTALL NEW DRAINFIELD
�( If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection
fee is $50.00, which must be paid in advance before calling for another inspection.
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 application herefor in strict compliance with all
ordinances pertaining they to 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 prop 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 coi dition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility fora thorough knowledge of the
ordinances and reg lions pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and that he assumes responsibility for work done
by his agents a an or oyees.
Sign (INSPECTOR) BY:
In considera a suance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity
with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either
myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
PERMIT NO. - I - 7 7
STATE OF FLORIDA DATE PAID: - -
DEPARTMENT -4F ,,,HEALTH FEE PAID: 7
ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM _
•� CONSTRUCTION PERMIT RE�E?,,PT 4 `
t -a- SDK
CONSTRUCTION PERMIT FOR `
[ l New System. [tj Existing System [N] Holding Tank [0], Innovative.
[X] Repair ,Abandonment [ J Temporary [ ]
APPLICANT:
PROPERTY ADDRESS: I l 7 1 UJ / 6"
} ,'�' f G t ,,: t t L f :, ; �' l /_ 0
LOT: `8 "B LQC 't SUBDIVISIONS
[SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
PROPERTY ID # z 10 L ) [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 ['� O C)l GALLONS / GPD SEPTIC TANK /AEROBIC UNIT CAPACITY MUL CHAMBERED /IN- SERIES [�•,]
A I I GALLONS / GPD CAPACITY MULTI- CHAMBERED /IN- SERIES [ ]
N [ _-.. ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK: 1250 GALLONS]
K [ l GALLONS DOSING TANK CAPACITY [ ]GALLONS @ E. ] DOSES PER 24 ERS # PUMPS [ ]
D [ - 2,v o ] SQUARE FEET PRIMARY DRAINFIELD SYSTEM
R [ -.- ] SQUARE FEET SYSTEM
A TYPE SYSTEM: [ :� STANARD [ ] FILLED [ ] MOUND
I CONFIGURATION: [ ] TRENCH [I BED I l
N f
F LOCATION OF BENCHMARK: 12, �.- Cta /``
I ELEVATION OF PROPOSED SYSTEM SITE [?�, Z] [ INCHE S /FT] [ABOVE / BE� LOTI�i ] BENCHMARK / REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE ESV,7Z) [IN S /FT] [ABOVE / BELOW ] BENCHMARK /RE FERENCE POINT
L
D FILL REQUIRED: [ 0J>u] INCHES EXCAVATION REQUIRED: [ ] INCHES -
A is.
s �.c'..ca eLle Odes' % if ijO'1444M3
T
Q //jjam� -
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R k ' 01 {
-, ;� ; E < °, a t��
jj A .. e 2
SPECIFICATIONS BY:
£
APPROVED BY: f, . t .k, -TITLE: `�- t< (• f J ( / l- t- ' t 3 CED
DATE ISSUED: 7 Z V Z EXPIRATION DATE=
DH 4016, 12/99 (Page 1) (Previous Editions May Be Used) Page V of . 3
pt. 1: Health Department
pt. 2: Applicant
pt. 3: Installer /Contractor
pt. 4: Building Department
OF ��
' O I
STATE OF FLORIDA PERMIT #�
Z] DEPARTMENT OF HEALTH
aoa ONSITE SEWAGE DISPOSAL SYSTEM
.�rycoA SITE EVALUATION AND SYSTEM SPECIFICATIONS
APPLICANT: r r_ AL W�os AGENT: tj� 1
/ i
LOT: a BLOCK: 7 SUBDIVISION: t j
f
PROPERTY ID.# [ Section /Township /Range /Parcel. No. or az D. Number
/.!_310 , oz� -a3rea
TO BE COMPLETED - ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST
PROVIDE t REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS.
-------= - - - - --
--------------------------
PROPERTY SIZE CONFORMS TO SITE PLAN: [ YES ( ] NO NET USABLE AREA AVAILABLE : .C)Ono_7Q� ACRE:
---------- --------- - - - - -- - --
TOTAL ESTIMATED `SEWAGE FLOW: 2Q Q GALLONS PER DAY [RESIDENCES -TABLE 1 / OTHER -TABLE 2]
AUTHORIZED SEWA16E FLOW: 1 07/ GALLONS PER DAY [1500 GPD /ACRE ORI PD /ACRE]
UNOBSTRUCTED AREA AVAILABLE: Zo SQFT UNOBSTRUCTED AREA REQUIRED: �' SQFR
BENCHMARK /REFERENCE POINT LOCATION: ,.. . J
ELEVATION OF PROPOSED SYSTEM SITE IS (INCHES [ABOVE/ ] BENCHMARK FERE N
THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURESy SWA SURFACE WATER: FT DITCHES/ ES: I+>�A FT NORMALLY WET? [ 1. YES [ yj�NC
WELLS: PUBLIC: FT LIMITED USE: _ . YI D FT PRIVATE: FT NON - POTABLE: J A FZ
BUILDING FOUNDATIONS: S FT PROPERTY LINES: 1( _ FT POTABLE WATER LINES: /0 FT
SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING? [ ] YES.
10 YEAR FLOOD ELEVATION FOR SITE: FT MSL /NGVD SITE ELEVATION: /b, - FT MSL /NGVC
SOIL PROFILE INFORMATION SITE 1 SOIL PROFILE INFORMATION SITE 2
Munsell Color '` Texture _ De nth Munsell Color Texture Depth
C.? J " to /O � 0 to
to
- to
t) to �b to
u to y to
to (���}� h to
to to
to to
to to
-4 t j . to — �
USDA SOIL SERIES: USDA SOIL SERIES:
OBSERVED WATER TABLE: IV INCHES [ABOVE / ELOW %ISTING GRADE. TYP CHED / PP
ESTIMATED WET SEASON WATER TABLE ELEVATION: INCHES ( ABOVE /
kp
LOW EXISTI NG GRADE.
HIGH WATER TABLE VEGETATION: [ E'S [ ] NO MOTTLING: [ ] YES [ NO DEPTH: &1A_ INCHES
SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING: S 0 4 DEPTH OF EXCAVATION INCHES
DRAINFIELD CONFIGURATION: [ ] TRENCH [ BED 61 (SPECIFY)
REMARKS /ADDITIONAL CRITERIA:
J l 1 -
SITE EVALUATED BY: DATE: / 7-22-o C
j'
OH 4015, 10198 (Replaces HRS -H Form 4015 [Page 31 which may be used) Page 3 of 3
(Stock Number: 5744 - 0034015 -1)
� N. STATE OF FLORIDA
DEPARTMENT OF HEALTH
, APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PE M.
Permit Application Number
------------- - -- -- PART II - SITE PLAN-- - - - - --
Scale: Each block represents 5 feet and 1 inch a 50 feet.
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Notes: hJ t I W 4
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5
Lai. &b - Alo wo 75 V K_ I ( A So M e — �•-
Site Plan submitted by: ,A L�
Signature We
Plan Approved '; Not Approved Dat ! = 2 " 0 z
-
B t {, .
y J .' Coun Health Department
ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENt
DH 4015. 0%pla= HF" FM 40 whkb ma r t, wed) Page 2 of 3
MW& 5jenbw. 6744.OQ 41MI54