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DS-09-568
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 ktWfrO, 141:' Scheduled Inspection Date: May 21, 2009 Inspector: Bruhn, Norman Owner: MANGHAM, ALICIA Job Address: 1065 NE 94 Street Miami Shores, FL Project: <NONE> Contractor: CHAMPION CONCRETE Permit Type: Driveways/Sidewalks/Slabs Inspection Type: Final Work Classification: New Phone Number arcel Number 1132050120100 Phone: (305)252-8055 Building Department Comments et- Inspector Comments Passed 9i/sr Failed Correction Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid. -... •■••■ nnnn Miami Shores Village lacmgEVICTI APR 0' 7 2009 , 3ulr� g p Building Department A ap %10, 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY . Tel: (305) 795.2204 Fax: (305) 756.8972 .tnD BUILD 1 G ®`s llotccvt �l��ct�. Permit No. PERMIT APPLICATION Master Permit No. FBC 2004 Roofing Owner's Name (Fee Simple Titleholder) /4Lta 9 ti k l 1 114N6- 1441Phone # Owner's Address 1065 me eel City.11,4451 Oiz state _ Zip 33 or Tenant/Lessee Name /• Phone # Job Address (where the work is being done) City Miami Shores Villa eye FOLIO / PARCEL # 119k 1 J C s.. my Miami -Dade 1,' Zip Is Building Historically Designated YES NO Contractor's Company Name CRAW iJ Contractor's Address 153 0 ,.�'ia.D City U v Qualifier Name 6A40) C) Phone # State Certificate or Registration No.a45 ) /5 Certificate of Competency No. ,c-4---0....5.5.54549476- . Architect/Engineer's Name (if applicable) Phone # State Phone # Zip .205 2-5-2 racy- 39b, Value of Work For this Permit Type; of Work: ['Addition ['Alteration Desch'le Work: Square / Linear Footage Of Work: 67-1-9 � w . ['New [' Repair/Replace [' Demolition LttalFee$ Permit Fee $ /�J ' 4�yO� �'l Jt� CCF $ ' 40 C6%re'° —`'- Notary $ 8'00 Training/Education Fee $ Q ' h NJ Technology Fee $ 3-111_ -' Scanning $ 1 '' ,, Radon $ Bond 1 4 * Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ .3 DPBR $ Zoning $ See Reverse side --> Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC 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. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement ust be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In t absen ' of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature f 9 I` • Owner or Agent The fore oing instrument was acknowledged before me this Oki day of 20U1 / , by C v k ■L'y tA<.! %( who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: NO Signature Contractor The fore oin l \instrument was ckno ledged befo e, e thi a ' day of ,l],j \i , 2 who ';s personally known to me or who has produced I0 t'TAT'E OF FLORIDA 0 Sign: Print: as identification and who did take Math. ®g PUBLIC: Commission #1)0491643 9 kgm GPs Ire * * * * * * * * * * * * * * * * * * * * * * * ** My Commission Expires: "091 ********************************* * * * * * * * * * * * ** ** * * * * ** * * * * * * **** * * ** * * * * *** * * ** APPLICATION APPROVED BY: (Revised 07/10/07) (4) 4//(al Plans Examiner Engineer Zoning NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. STATE OF FLORIDA: COUNTY OF MIAMI -DADE: TAX FOLIO NO. THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided In this Notice of Commencement. 111111 11111 1111111111 11111 11111 11111 1111 1111 CFh4 2OO9RO279915 OR 8k.26832 Ps 0763; (1as) RECORDED 04/17/2009 09 :48 :16 HARVEY RUVINr CLERK OF COURT MIAMI —DADE COUNTY, FLORIDA LAST PAGE 1. Legal description of property and street/address: 4065- Age- 404 or rIA 5 t f-t 3'31/31 ' 2. Description of improvement: 3. Owner(s) name and address: (06-5 A--)0 tf44 Tri,citeJJ. 3313- Interest in property: Name and address of fee simple titleholder: 4. Contractor's-name and address: tD 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as )xovided by Section 713.13(1Xa)7., Florida Statutes, Name and address: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the•Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and address: 9. Expiration date of this Notice of Commencement (the expiration date is 1 year from the date of recording unless a different date is specified) - 041 eYVVAtfilaVIr■- Signature of Owner j j� Print Owner's Name o chQ.j1 i r' a A. Sworn to and subscribed before me this to day of ' \ , 200 1. k ID . Prepared by JArde-- IitSJL Notary Public Print Notary's Name My commission expires: \\ '._ a. Commission # DD491643 1 :n Address: y5310st/ J /1(77 A N'), /1,-- 9 / 123.01 -62 PAGE 4 8102 1-7 Expires; WV 17,„ 2009 Bonded Thrtt 4444RW OPIAtTig c.13.4 inC. 'STATE OF FLORIDA) COUNTY OF DADE) n� The undersigned Affiant, ! Y ► + j 0/1 (property o attached survey, performed by L16D A434,4 4'1450e. (name of surveyor's company) does hereby attest that the performed on —17— f r , is an accurate representation of the.existing conditions and (date of survey) locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than six (6) months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted -or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. Witness(sign and print) Wit1,62f2, AffiantlProperty owner Witness(sign and print) SWORN TO AND SUBSCRIBED before me this. day of Affiant is personally known tome, /produced 4-1 produced as identification. NOTARY FUBLIC4TATE OF FLORIDA Gisela Basillo. Commission #DD491643 Fxxpires; 4 ® 9 ffiamj ShoreJ 10050 N.E. SECOND AVE MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (3Q5) 795 -2207. :.:Fax: 13Q5)_?5641972__ COVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, ( 94 i.. 77A KM 11 , hereinafter referred to as the Owner ofthe (owner) following described property: Legal description/folio #: Lot Q Block Subdivision 14 Tax Folio #: I1O5OODO requests permission to install: [.Asphalt, concrete, Vick pavers [ ] Landscaping []Other is 01 within the public road right of way of ( fit - y` IN CONSIDERATION of the approval of this (address) PP permit by the Village, the Owner agrees as follows: • To maintain and repair, when necessary, the above - mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason ofthe Owner's failure to do so, such expense shall be paid by the Owner or shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnify and hold Miami Shores Village or dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove or relocate their facilities at their own ex notice by the Village to do so. Failure to comply with this notice will result in the Village within 60 causing the item(s) to be removed and a lien Ding. placed an the property and/or assessed against the Owner for all • costs incurred in the removal and disposal of the item(s). The undersigned d� nay further agrees that these conditions shall be deemed a covenant running with•tiie land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED A N D ACKNOWLEDGE on this Le d a y of 14 • 0 SIGNED, SEALED AND DELIVERED in the presence of } ise a Commission # DD4916j3 Expires; NM 17, � vel Ailru Atlanta Bonding Coq Ar,k7.4' frt Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Permit NO. DS-4-09-568 arm Tye Drive Issue Date: Not Issued Expires:Not issued Folio Number:1132050120100 Owner's Name: ALICIA MANGHAM Job Address: 1065 94 Street Miami Shores, FL • Owner's Phone: Total Square Feet: 620 Total Job Valuation: $ 4,000.00 ................ • .............. •-••••••• .......... Contractor(s) Phone Primary Contractor CHAMPION CONCRETE (305)252-8055 Yes Planning and Zoning Criteria and Comments Approved: Yes Date Approved: 4/8/2009 : Yes Comments: MAXIM WIDTH WILL BE 12 FOOT DRIVEWAY WITH 2 FOOT FLARES FOR A TOTAL WIDTH OF 16 FEET AT STREET Permit No: 09 -% Job Name: C% , 2009 Miami Shores Viiiage Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 LJ ArrCJ(C/C /7/, 5 latiCOUd Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204 uvvsa . • . • SCALAa NTS Ur& p-z1i ovet-cs. 11iffi Pi" ' V /0.4am4 Usti i Dim lOwefaee emotes Cdm Clem.. eAW%5nawaa HE w.,o.+•.•� 'ilai NOR&BAi mosaued ado de QS ea¢rheia, a train as beef on Mu dma *ITN, w, ten not *Waned for fosemods creator ridaa rtfa oeshown co Blauaaafisaaes.il< Mostam Wean co Wee& y Ua eueea et F Fem+ea traeetaamr verso t a taw es Pone *eta sae , of DWI • ametteveaa,s f 'sad. Sit as t w� dam Pnelimh remoras. a # Miami Shores Village APPROVED I BY DATE ' _. ZONING DEPTjI 1BLDG DPT' + Ii_.- SUBJECT TO COMPLIANCE WITH ALL•FEDERAJ STATE AND COUNTY RULES AND REGULATIO Certified to ?diehard. J. Nanghme, Alicia A. 1dangha s, use D.E. 94th Sb. Magai, Shames. Florida 33235., Christopher P. Kelsey, P.A. natal, u .. National Title Issance Company of Pennsylvania, Hayhurst And Aneooiatee, Inc., ita anoeeaeorn and/or assigner Oulfntram Title Company. {LM•, : rnlabe MEW AccoaOING TO TIM piiernauforas IK PutT Ai' woad 44 • OMB PUBLIC OS OP ..CCUNIT.A.ORMA, 801$103ANYVURVISY 1 cal Yremu. ana.oeneM' aowpwDkripw wows to d:Om.tldt hap let rrma W+omimpa AM4p Wrwn,a set nrau p .d,7, tno!.,r,= n 1M.# NARK K. ERACIATH sessesatessausayot Seto of BL.ANCO, DANIAI. & ASSOC. INC. Stamm 4108 aurora St.. •{ g Address) Coral Gables Pl. 33148 553 N. $acts Dr. Seib s • Sib. Heaoh 51. 33141 110: I Nei 1., i7.96 1•+a20. 0093 tit Fdx- (3 115)585 -7$10 UMW; e.7 DATBi 31x/941 : attplier 1 124510: WM WA F&trio ?G- ih(e. ono PIPIRlati •BLDG DCPT' SUBJECT TO COMPLIANCE WITH ALL•FEDE STATE AND COUNTY RULES AND REGUL.ATIO _ataY3't'AR�f+' =ter+ �. • Qont/.?t 4.0i 114.0 cog Ft -D1) • 414". SI tibial lran Piper al•wemca beta 4 sine 61 aSOt1tN, 7NE PQL3.01MHO NOTES AFPLL ,sensed a is tiro in sob amuse ag lnttenY 2} aeon*. it shams we Innen on t 8 data. n •Rte 1IIe41 W*1$ ate4 abstradee f*r Easements aaa alder tubrAbd aaaetnnnonras b t *ham on 1h*pia aim The abase. N Wilma on Itis aTntd4 4y} t>�r�adergatund mewed franenw4 InvandaiMI wan= Improvements vane net Sts lainn Ire base on Kt4 *naf wade la Mum @j Pennegoor ate to Su atent a nn of gt! tense, 71 Vat) et eteninn 8 h11Aa1e}l Stew,,.. brae= nn aN *Adds oats silo—' _sates - • esselon mss. tvcsvoaw tar banns 6 • Certified boa llicbael J. 4fangltam, Alicia A. 1laangbar, 1063 V.I. 94th Sb. iEttgai Shares, Florida 33138., Christopher P. X11417, P.A. , Pi3eli National Title lnsarance 0olapany og Pennsylvaaixi. I1ayburs3 and • Associates, Inc., its successor's attdlar assigns, Onldstraam Title Company, t cION t • i setildhel AV Want) LECALDIONFit Max MUM WOE= MOON . OF 0.1800:1StON AcOO601NOTomaPLAT7t4 ?REOPASageoRfEDINPLATscoxi ..ATPAGE 44 OPiti@ PUBLIRA600R0S0P. 4822..-- CDUNTY.FLQRtDA. 6OUNDANT ¢URY@Y 814410 gamey tau me ar ,nenetasr ntra+.xtn wtevmretaawmnyw.me0% UMW seasaTttnoexeatw 411 M .e trr twt..t. ro ataae 4at:aN Feree atm Iran Re stiallftwa6400041115 400.0.11 .gips Ss $401 t«rw..ama,. Act :11.86 Et. KRAJP%'ER Realnata nand 8enoyat Na 3371 Slate of Kolas BLANCA, DANIAL. & ASSOC. INC. Lptd Swrywb • Phones: 4100 Anrora St. ,ladling Address) Coral Gables P1. 33346 533 N. Shore Dr. Suit B AA. Beach 31. 33141 (303)• 863 -1200 lids.- (314)06-7010 :a t :J T j 3 /2 /04 B4SE: 8° Q v:meg /LOO* WONh A it =•: 0013 t.- 17- 9(, 11Q 20' OWN. at • to CO Jos H*. /9j to APPLICATION FOR: [ ] New System [ ] Repair STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM [X] Existing System [ ] Abandonment APPLICANT: Michael Mangham AGENT: [ ] Holding Tank [ ] Temporary APP Doc #: AP921563 PERMIT # : 13-SC-981085 DATE PAID: FEE PAID: RECEIPT #: [ ] Innovative [ ] MAILING ADDRESS: 1065 NE 94 St Miami, FL 33138 TELEPHONE: 1(305)754-9601 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTMS. IT IS THE APPLICANT'S REPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM /DD /YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. LOT : 10 SUBDIVISION: Kirbys Add to Miami Shores PROPERTY ID #: 11- 3205- 012 -0100 PROPERTY SIZE: 0.18 BLOCK: PLATTED: 01/01/1940 ZONING: ACRES WATER SUPPLY: [ ]PRIVATE [ Y N IS SEWER AVAILABLE AS PER 381.0065, FS? PROPERTY ADDRESS: 1065 NE 94 St Miami, FL 33138 I/M OR EQUIVALENT: [ Y 1 N 1 [X]<= 2000GPD [ ] >2000GPD DISTANCE TO SEWER: FT DIRECTIONS TO PROPERTY. I -95 north to 95 St head east to NE 10th Ave turn right to NE 10 Ct turn left on 94 St to house on left. BUILDING INFORMATION: [X] RESIDENTIAL Type of Establishment No. of Bedrooms 3 [ ] Floor /Equipment Drains [ ] Other (Specify) SIGNATURE: [ ] COMMERCIAL Building # Persons Total Design Flow Area Ft Served .n This Unit DH 4015, 09/2006 (Previous Editions May Be Used) a 1.0.0 AP921563 810981085 DATE: 05/05/2009 400 Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM Additional Notes and Comments: County Notes Fields: County Process #: APP DOC #: AP921563 PERMIT NO. 13-SC- 981085 DATE PAID: FEE PAID: RECEIPT #: County Permit #: Storage Box #: This perm existin s granted : repia « existing stepping stones to pavers on existing driveway. Does not have any impact on STDS. v 1.0.0 AP921563 EID981085 STATE OF FLORIDA EPARTMENT OF HEALTH APPLICATION FOIIONSITE SEWA$E DISPOSAL SY$TEM CONSTR CTION PERMIT • Pennit Applleat riNtiniber " e .110.! 41.1,W 31=IIMI• AMMINNI ••=.10 t■■•• •I■1 111■M Or0•01 ■■•RMW PART 1,1 sn-E pLArst. , .Scalet :Each-Wok represents '5 feetandl." 17147F77717;7791: _ • , t • Ht -.i•-•,il-H-T-a+Trryt-4 ir ••• ••• +.1„4-444-4-17-1-11- rtr-- --H-H-tt17 4 - • t 4 • g "r""rrvi- Notes: ... ..,, ... ___ ". 1, , • 41-41-- 4 -4- 11in -- . 4.4, .4+0- '- t 44 441t t. - 11-1-4-- 11-14-1 , 47-111 L-1-4-4-+--t' .,„ .. ,......",,..., ....._.....,....,......., --:.---, - 11 I' Title Date ti-30-3 5' Site Plan submitted by: Plan Approved By County,Health.Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEALTH DEPARTMENT Poge - 13144015, 10196 (Replaces HRS-H Form 4015 vihich may be used) . , (Stod( Number: 5744-00?-441-k,13), „ , , - - STATE OF FLORIDA DEPARTMENT OF HEALTH APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONST UCTION PERMIT Permit Applicat ori Number ammim .,■••• — — — — — PART II - SITE P Scale: Each block represents 5 feet and 1 inch =50 feet -- i4-77:1711"1-1-Frrrrrrrrtcr- i, mil- -v ,'---,. ."..t-i-i: f i 7- 7 • it-r-1.-- ITT i--171-cf ri-1-Tricti , 1.--r-t-r-ri 1---i-4-1-i-t--f-++-+-tl---,-r+--H4-4- t- --'•--. LI,-.44-44-444-1„--10-1--++10-1•••-t--00- 0„.•• 4„-f- .4-1-1--01-0-1-4-04-4-0-4-4-1-4-t-1-4-4-4.- -44--1- L' 1 j.. i L L. •i .. , . i__LL2 t,i 4-4„-- -,- --0 -„,----- f.,-, -rt.,. .7---r-t- - (-4- ' '-4---! --1-4.-„-1-1,44-1,4.+ -4. . • i 1.4 .-r1-1-1-1-1-1-A1-1-./-) -1- ( i 'Cr.'•+.1- --1-1..--t• f+1-1'.--i-1-1-1-113---117-17) r4-1-1- • -t- Fi-i--1-11-+-+A- •' Fril-----ri-4-4-i•-• 400, -„ ' , ..1 ft. ',„----„--, ---1,..++-4-4-4.„---,„-----. ; „ , i • c.- ir-T-T-1---r-t-trril . „, ri-4-4--AA, 4,--1--- -4-1-1-4:-H-1--f -A---A----- ÷1 -f- r-r4-4-4--44-4,-4-4,44,44 0.1.11_4_11,„(„Tri..t.t.4.4.4...1„..,4.,A7 P-Arr-r-4-1-AT •• 1-- i .1-4---.. .1.-- ' 71--7471--A+71-14- ..,..-1,4-1.-14 • ...( r.., „, • , 1 • ‘,3-elf „ „. 1-n7- cri---t-tt , --,--1- 1-1- -1-1' H.T7...1171.7:.„4-47triT1174-1.1,71„-.4 „•-• - 4 71-r-t4-i 11 „ LLLLLF411 -t-.4-4-4 • -1-- 4, L FHI 1T „t - a,-t— t ',...44.1_, if-'• t ' , -1- i i . • :--(„„--f---ft--tt-H•-(f7t-t-i-•-t-t-++' 44 :*--Ft----A.,1 -+A - ,A..W ;-, '• • + +1-A-- 1 . - --A -r ' i: -., 1,.....,.. . , (eA)- )--• 4-4-1---+-4,--1- -1----A---1-1,4-1- 'y' --+- --1.---e-t---t--t--,--t-i-t. -±--t-4..+-4--4.-4--- 4J.:11- 1-44.-1+ • ' 4.-1---4 „ ; '- --i--1-1 - : . - --.. j... 74-1-i 4 - +- -i'- -1 , .,-J.-t++-4-1-t- ' .,..,- . - • - 1 '... , -4-41 4-- , ; , . . '.,.., .1 -1 L-444-4-4-1-±f± J-1, :I t Notes: - 7'hft 4 .41 -114ft..-14_T-i'tt;1:4.17.1.414,117,,11Tlift--4,..43-.7-14---4_4-41 Site Plan submitted by: Plan Approved By proved Title Date ti-yei—ci, County Health Department ALL CHANGES MUST BE APPROVED BY THE COUNTY HEAL DEPARTMENT DH 4015,10/96 (Replaces HRS-H Form 4015 which may be used) (Stodc Number. 5744-002-4015-6). .„ ; Page 2 of APPLICANT: LOT: / 0 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS BLOCK: suaDivi4sI PROPERTY ID 0: , /,. 2Z - -c (Lr O / O C) ==========_===================-==== TO BE COMPLETED BY ENGINEER, HEALTH UNIT EMPLOYEE, OR OTHER QUALXFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. ============_==_===_==-1==_-__====_==-==- =====w =ma------ - ----- tea =massy PROPERTY SIZE CONFORMS TO SITE PLAN: [ YES [ ] NO NET USABLE AREA AVAILABLE: (/ ACRES TOTAL ESTIMATED SEWAGE FLOW: &a GALLONS PER DAY [RESIDENCES -TABLE 1,j AUTHORIZED SEWAGE FLOW: GALLONS PER DAY [1500 GPD /ACRE OROPO GPD /ACRE UNOBSTRUCTED AREA AVAILABLE: SQFT UNOBSTRUCTED AREA REQUIRED: -b Q n SQFT oN= r lys / 7g 44,h, l e/v-4 [Section /Township /Range /Parcel No. or Tax ID Humber] PERMIT # • • BENCHMARK /REFERENCE POINT LOCATION: ELEVATION OF PROPOSED SYSTEM SITE IS /FT] [ABO CE POI TEE MINIMUM SETBACK ,WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURE): SURFACE WATER: /"f4 FT DITCHES /SWALES: #/ FT NORMALLY WET? [ -] YES NO WELLS: PUBLIC: a'%4 FT LIMITED USE: N ✓A-FT PRIVATES "OF __ FT NON- POTABLE: /v�i$- FT BUILDING FOUNDATIONS: FT PROPERTY LINES: 5 FT POTABLE WATER LINES: / FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [of/NO 10 YEAR FLOODING?.‘ [ ] YES [vi' N0 10 YEAR FLOOD ELEVATION FOR SITE: 5-4 FT MSL /NGVD SITE ELEVATION: (.o FT MSL /NGVD SOIL PROFILE INFORMATION SITE 1, SOIL PROFILE INFORMATION SITE 2 t_ to 77 to to to to to S ERIES: ,y ,}�� OBSERVED WATER TABLE: I`1/4- INCHES [ABOVE ESTIMATED WET SEASON WATER TABLE ELEVATIO : HIGH WATER TABLE VEGETATION: [ ] YES [ NO SOIL TEXTURE /LOADING RATE FOR SYSTEM SIZING DRAINFIELD CONFIGURATION: [ ] TRENCH [‘,1 BED [ ] OTHER (SPECIFY)' REMARKS /ADDITIONAL CRITERIA: STING GRADE. TYPE: INCHES [ ABOVE MOTTLING: [ ] YES [ a N PERCHED EXIST ;E PTH: ___ INCHES 70 DEPTH OF EXCAVATION: tilA INCHES' SITE EVALUATED BY: /0-Y; DH 4015, 10188 (Replaces HRS -H Form 4015 (Pape 31 which may be used) (Stock Number. 5744.003- 4018 -1) DATE: V.-3V ? 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, PAC. 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: FLOOD INFORMATION: SOIL PROFILE INFORMATION: WATER TABLE: SOIL TEXTURE: 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. Record information on lot's subject to flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. 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. 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. Record soil texture or loading rate for system sizing. DEPTH OF EXCAVATION: 1f applicable record depth of excavation required. Record "NA" if not applicable. DRAINFIELD CONFIGURATION: Check drainfield configuration required. If other, specify type. ADDITIQNAL 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 englneen must seal all documents submitted. ELEVATION WORKSHEET ELEVATION OF BENCHMARK / REFERENCE POINT IS: BENCHMARK SITE 1 1+ ] SHOT H.I. H.I. [ - ] SHOT SITE 2 SITE 3 H.I. H.I. [ - ] SHOT [- .]SHOT • STATE OF FLORIDA DEPARTMENT OF HEAL+ ONSITE`SEWAGE DIS SYSTEM SITE E V A L U A T I O N ANDS STEM.:SPECIFICATIONS APPLICANT s " C/j 4 AGENT: ..,a , y` I4C 0J c. J lClL1, �y g� .� S P SL C- PERMIT i# LOT I PROPERTY ID >: 7/ t % BLOCRs SUBDIVISION: i i Q , P `. � r a ; 3205---0 IL-- d 10 [ Sectioa /Tcswuship /Badge /Parcel No. or Tax ID Numper] TO BE COMPLETED BY ENGINEER, - HEALTH UNIT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEER'S MUST PROVIDE REGISTRATION NUMBER AND SI AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. a == == = = = == = =,aaa= N— s -- - == === = =as == sa = ===== =mass PROPERTY SIZE CONFORMS TO BITE PLANS -[rr YES [ ] NO NET USABLE AREA "AVAILABLE: • ". ACRES TOTAL ESTIMATED SEWAGE FLOW: 6 GALLONS PER DAY (RESIDENCES -TABLE 1�/ TABLES AUTHORIZED SEWAGE FLOW: " rI GALLONS PER' DAY (1500 GPD /ACRE OR(25d0 GPD /ACRE UNOBSTRUCTED AREA -AVAILABLE ©A SQFT UNOBSTRUCTED AREA REQUIRED: c 0 SQFT BENCHMARK /REFERENCE POINT LOCATIONS' P Ca Q NATION OF PROPOSED SYSTEM BITE IS �1�TC l*/FT] [ABO : » •W3 C:i ►. REFERENCE POI .' THE MINIMUM SETBACK. ICH CAN BE MA NTAINED,FROM -THE PROPOSED SY TEM TO THE FOLLOWING. FEATURE SURFACE WATER: PTA FT -• (ITCHES /SWALES: #74 FT NORMALLY WET? [• -]'YES t1] NO WELLS: PUBLIC: P74 FT LIMITED (USE: • ,e)- FT PRIVATE: A/74 FT NON - POTABLE: •%'4 FT BUILDING FOUNDATIONS: FT 1I'-PROPERTY LINES: FT ' POABLE WATER LINES: L• FT SITE SUBJECT TO FREQUENT FLOODING: [ ] YES [ NO 10 YEAR FLOODING?tt [ YES [4 NO 10 YEAR FLOOD ELEVATION. FOR SITE: • ",% FT MSL/NGVD SITE ELEVATION :! (9,9 FT MSL /NGVD 4. SOIL PROFILE INFORMATION' SITE 1'` OBSERVED WATER TABLE :' -__ INCHES ESTIMATED WET SEASON WATER TABLE HIGH WATER TABLE VEGETATION.: ,[ ] SOIL PROFILE `INFORMATION 'SITE 2 Depth to O t.- to _...� to 7Z to to to USDA SOIL SERIES: ;� >Z a [ABOVE -� BELOW] E STING GRADE. TYPE: PERCHED ATIO s %- r INCHES 1 ABOVE.( [ NO MOTTLING: [ ] YES [ 'SOIL TEXTURE /LOADING RATE FOR SYSTE$ SIZING: / DRAINFIELD CONFIGURATION: [ CH. 1 ]'BED REMARKS /ADDITIONAL CRITERIA: D)PTH OF ELEVATION: OTHER. (SPECIFY) ] EBISTIN( INCHES INCHES" SITE EVALUATED BY: DATE: V'.?€ -0? DH 4015, 10198 (Replaces SIRS -H form 4018 (Page 31`wh&c may be IUsed) (Stock Number 8744003 - 4015.1) INSTRUCTIONS: PERMIT NUMBER: APPLICANT: AGENT: LOT, BLOCK, SUBDIVISION: PROPERTY ID NUMBER:, PROPERTY SIZE: SEWAGE FLOW: Permit tracking number by County Health °Department. Property owner's iitli name. Property owner's legally authorized representative. Lot, block, and subdivision for lot. 27 character number for property (property appraiser ID number or section/township/range/parcel number). 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 bodisa of water. Record the estimated sewage flow for the establishment frodl Table 1 (residence) or Table 2 (non- residential), Chapter 1OD-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. UNOBSTRUCTED AREA BENCHMARK INFORMATION: MINIMUM SETBACKS: FLOOD INFORMATION:. Record the square feet of unobstructed area available and the amount require& 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. Record the location of the benchmark. If using a surveyor's benclunark 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 Hsted features. Actual measurements must be recorded or "NA" for nonapplicabie'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. Record information on lot's subject tb flooding. For lots subject to flooding record 10 year flood elevation for site and actual site elevation. SOIL PROFILE INFO ATION: Two soli profiles within the proposed absorption area to a minimum depth of 6 feet or refusal are requited. Soil ,i identification will use USDA Soil Classification methodology (Mansell colors and USDA soil textures). Refusal& must be clearly documented. Provide USDA soil series if available, record "UNK" if the series cannot be WATER TABLE: SOIL TEXTURE: DEPTH OF EXCAVATION: determined. 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. Record oil texture or loading rate for system sizing. If applicable reco d depth of excavation required: Record "ETA" if not applicable. D R IELD CONFIGURATION: Check drainfleld configuration required. If other, specify type. ADDITIONAL CRITERIA: SITE EVALUATED BY Record any additional remarks pertinent to site or installation. Ex. dosing required.. Signature of evaluator, title, and date of evaluation. Professional engineers must seal all documents submitted. ELEVATION WORKSHgET BENCHMARK [ +]SHOT H.I. ELEVATION OF BENCHMARK / REFERENCE POINT IS , SITE 1 H.I. [ ] SHOT SITE 2 H.I. [ -1SHOT SITE 3 H.I. - 1 SHOT STATE OF FLORI A DEPARTMENT OF ►LTE ONSITE SEWAGE ISPOSAL- SYSTEM APPLICATION FO CONSTRUCTION PERMIT APPLICATION FOR [ ] New System [� 1 Nxi ing System' If ] Repair [ ] Ab doament APPLICANT: g ► .tc r \a1 AGENT: MAILING ADDRESS: 1-062C- Ns) Raiding Tank Temporary Innovative TO BE COMPLETED BY APPLICANT • APPLIC NT • S AUTEORIZED AGENTt SYSTEMS MUST o 5E CONSTRUCTED , BY ..A PERSON LiCENSED PURSUANT • 489.105(3)(a:) 08 489.533, FLORIDA STATUTES. PROPERTY INFORMATION LOT: \ 0 BLOCK: ter.. SUBSIVISION: ih PROPERTY ID #: 1 1 -33,05- -. 0 I : ono PROPERY SIZE: 012 ACRES WATER SUPPLY: [. I/M OR EQUIVALENT: [Y/N1 PRIVATE ;PUBL4C [ < =ZOOOGPD [ >20000PD IS SEWER AVAILABLE AS PER 381.9p55, FS? [ Y /(l�)1 DISTANCE TO SEWER: PROPERTY ADDRESS: 106:f m a 4 s - Y V `J aL yv , o FL- .3q DIRECTIONS TO PROPERTY: c115,_ E (} f f - h q ,C, J' + 1--1 E}Orri r) Na t DOE. ' .T r - Rk91n k � o E to cf Torn (fir ti Oct q 5+ To 4--i ovs .., o n BUILDING INFORMATION Unit Type of No Establishment 4 R Floor /Equipment Drains ti ., RESIDENTIAL [ ] COMMERCIAL o. of Building Commercia /Institutional Systa Design edrooms Aria Sgft Table 1, Ohaptor 541 -6, FAC �. c.cfV C he y\ i n f ra u w. \ PRDm 5 {2rV iv FA\R Ja f DH 4015, 10/97 - Page 1 (Previous editions Tnay'6e used) Stock Number. 5744- 001 - 4015 -1 ] Other (Specify) 041 Q/1 m,Qh —L - Page 1 of 3 APPLESATiON PO& Ch type of parma, t t•Othzr" opetlfy type la blank. APPLICANT: ;, Property era fu nails; AGENT: a Property owner's ieeally authorized rep 4 ' =ntative. TELEPHONE: , - Tph ne numberfor pi nt or 'lent. MAILIN3 ADDRESS: P.0„ eox or str t, city, Mate pal zip al', melting addreas for applicant or agent • LOT, BLOCK, SUBDIViSION: DATE OF SUBDIVISION: PROPERTY I as, • ZONING: PROPERTY SIZE: P, • WATER SUPPLY: SEWER AVAILABILITY Lat, block, and elbdivislen for lea (7mid.521 or urrezeoled aorarli° *ion). If 11C's is not in recorded subaMSIOTI, copl,f of the t4ii iegai deseaeaen d.:46.'";i1 must be reched, Oftsaal data ef JI eivision recorded in ai ray pt books (monttaday/year) c date lot CfriPinA7 FCSVrAA., Diviefines ao approval k Inte a5lo ill'rre rIFSC4314 for the purpose of recyioe easeership still .L zero; su n of the • • • • 27 character number for properly. CHD require property appraieer ID st or '- section/township/range/parcel numsor. Specify zoning and whether or not prooarty is in UM zoning or equivalent usage. Nat able a. se (a r oprtyku (clurffo foo go diotaosi by 43;530 square feet) exclusih, i. of ail pease! &rear asaa aaaservaroad tit-do wr !rift riehts-of rely or • easements era esaausese Remaly teal-age ,eitches, tosraaak Or other such bodies of water. Contiguous unp ved and nortcornpacted road rights-ofrway nd easements with no s • if sou eltastructia may be Iriduded. In calcsaating lot area Check earaate or public ea 2000 gallons per day or public a 2' g Dons par day. Is se r available as per 381.0035, Florida Statutes, and dance to r in feet. PROPERTY ADDRESS: Street add for I party. For Iota without an "gnau street or Toad and louts in county. DIRECTIONS: Provide detailed instructions to lot or attach an area BUILDING r,M,FORMATION: Check antisl or al. , ress, Indicate street rig lot I lion. • • TYPE ESTABLISHMENT: List type of eat bliaa,ment from Table II, Ci/o Fetes 100-43, FAC. es: single family, . single • - a aurora, da tee NO BEDROOMS: a-. Count all to e s designed areas expected to routinely provide sleeping a atia. ri-11! offorr.staTIP.1,,nogts!id th • . ,.- BUILDING AREA: Total square footage of end habitable of . 41Ing unit, excluding garage, ca . exterior storage shed, or open or fully screened patios or decks. Based on outside me surements for each store of cture. BUSINESS ACTIVITY: • For a. erdalanstituaonal applications only. List n bar of ployees, shifts, and hours of ope -Ion, or other Intonation required by Table II, Chapter 1# • ; FAO. -- • FIXTURES: % Mark Floor/Equipment Draine or Others "•11 SIGNATURE / DATE s ' Signature of apph or agent Date appl • fees and attaa. ants. specify item or "NAwif not applicable.- on su ed to the CHD with appropriate ATTACHMENTS: A site plan dr sA <N le, showing boundaries with di :,11Siefte, locations of residences or buildings, swimming pools, recorded easements, onsit; sTeJage dn 1 system • pon nts and location, slope el properly, any existing or proposed wells, drainage featuree, fined areasa, o cted a , and starface ;ter. L. a'on of wells, onsite se go disposal sytearris, surface salters, tea ath p ies or feseo p„ on acent r rty, if the features are with 75 feet of tine Applicant lot Location C any puale %a4ra eaah.n 200 feel oflot. Fer realdenaaa, a floor - plan (reeidences) showing number of bedroom and LeEdIng a of ch unit For n • n ' mead esteallshanots, a floor plan sho *ng-th square f • e age of the estealistigrient, all raimbing drains and retypes. and other features n ry to determine composition and gu ittily of wasie ter. . - *goo .4 • • di" team* aftorff,. PIP910# • :at i=imamvziniiam'- Mt" duo. si PIP= POOlnd 2 162O Pips wow. Vali 1 Dist gleiAA) "SeeeirenD et'S i (4%*144 Liketeont totaeoft t Glee. . NOVINfuno. Inor indent 4 ODBIRWRIE SHOWN THE ifOLLOYANG NOTESAPPr4 MID1D/Dd =1_14 DID in 4$22111[3021 reimIni Z Efealwa. If sham in lased GA Pial, 422. 3) She 14421 • OM Dal ablifacurd fcr gettalnants as alba flata2201 locumbranewi wit shown On Oncl Pm tem 11 sort to down on Iles /faith 4) UndarrounO rank= of Posologo, Foundaleev, « Our norratomonso lent not food Ekilo rm we woo on Room Gtodefeo yawn. 11 Fence Two No to eta Calasoint of ie. hue._ 7) Imo tlet I ate et lhaWall 8 188yall %wrangle/A-obi= To .W p'itakia rang FiaTh—is wag_ • • ■r% • t.r to Si .k S CaloE ..!;" 2:32 dik M jai; roS 'Id AP3FIOVE0 ZONING DEPT DATE : ) SUBJECT TO cpmpuANci WITH AU...FEDERAL STATE AND COUNTY RULES AND REGULATIO S Carl:1E1E1d bol 1iabaeJ. 1. Waagbwn, Alicia R. nunolies, 1005 LE. 94th St. Masi Shores, Florida 331311., Christopher P. Kelley, 11.a. !Wail National Title Insurance dorapeep Pennsylvanid. Hayhurst And • - assoalates, Inc.. its successors und/cr assigns. OulEstruen Title Company. MUNZEall : Meat) Mal multima iuw Nlanl siois A BLOCK OP SUBDIVISION ACCORDING 10 1116 PLATTHNRROP AS PIIMORDED #IPLAT 0:30nAk.."2' PAGE 44 OF The PUBLIC ENCORCRI CP ..IIina.--.COUPPrf. FLORIDA. PURVEY HMV caner rMzffil ante nitionsts nottnott OftentuattrintInshitotItIMS cow tom sursomamo44444.1u44 =744 ,4..s nosige Ott* gum Stift sts stoseentasosits diatom MOW% VI OM WU .ribit oteat WM DO 4.6.1PONet Azitiltt BLANCO, DANIA!, & ASSOC. INC. 81nvey co • Room 4100 Aurora $t. imbuing add teas ) Coral Gables Fl. 33145 555 N. Store D. Sat El UL. Bloch P1. 33141 305 86 -1200 76x- 35 865- 10 ARK N. N811214111 Reclimar401.8441 &mom me 3371 Sena of Ronda IAR,VZ t ,