PL-07-2218Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
P
Project Address Parcel Number Applicant
................ ...._ .......,.. .W,..,..,....,....._.._..., ......, .., , ......�........ w
1460 NE 102 Street 1132050240250 JEANNE EKLUND
Miami Shores Village, FL Block: Lot:
.............................. .....e...............>......... YYY F:•:•:•:•:•:•:•: YYY•: Y•:•:•: 4: YY?:•:•:•: Yr,.:.:.}:• ;.•.}:•;r,.;Y.: ?:KY•:•:•:•:4:•.
�..•.v:,.::: .. :...r.•<.• <Yp:•'•'•'• Yp:•::•. •.• <....•r.•<Y:.. <n•..:•ear,Yr, •.•.•.::..• ...•r.,:FFY<: {:::.:..cvv;Y >.;:. }:•:error n•.•:.•::n:..
. ....................>..•:..::.......:. r.•..•.>.>.:.:....•. 1. s........•..•....❖. Y..:::::•:...::>..»>..>...>.....::... v>... ..... >... :....>....v.. > >. : : :..: :.• r:::::<..: ... :. : : :rrr :r <.ii :•i........ :1.
JEANNE EKLUND
1460 NE 102 ST
MIAMI SHORES FL 33138 -2622
Contractor(s) Phone Cell Phone
MR C'S PLUMBING SEPTIC INC (305)651 -7859 (305)651 -5652
Type of Work: DRAINFIELD
Type of Piping: PLUMBING
Additional Info:
Bond Return:
Classification: Residential
Fees Due
Am]$3.00
Bond Type - Owners Bond
$3
CCF
Education Surcharge
Permit Fee - Additions/Alterations
$1
Scanning Fee
Technology Fee
$Total:
$491
........................................................ ...............................
I Valuation: $ 2,000.00
t Total Sq Feet: 400
I Total I Amt Paid I Amt Due I
$ 491AS $ 491.48 $ 0.00
Payment Type: Check / Number: 1220
LODE, D
Available Inspections:
Inspection Type:
Rough
Final
Landscaping El
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 .
October 31, 2007
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
Wednesday, October 31, 2007
e.
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 06/11/2008
Inspector: Levrock, James
Owner: EKLUND, JEANNE
Job Address: 1460102 Street NE
Miami Shores Village, FL
Project: <NONE>
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Drainfield
Phone Number
arcs/ Number
Lot:
1132050240250
Contractor: MR C'S PLUMBING SEPTIC INC Phone: (305)651 -7859
Building Department Comments
REPAIR 400SF DRAINFIELD
spector omrrtlents
Passed
C
Failed E:1
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Tuesday, June 10, 2008 Page 2 of 2
STATE OF FLORIDA
DEPARTMENT OF HEALTH
ONSITE SEWAGE TREATMENT AND DISPOSAL
SYSTEM
CONSTRUCTION PERMIT FOR:
APPLICANT: Jeanne Eklund
OSTDS Repai
PROPERTY ADDRESS: 1460 NE 102 St MIAMI, FL 33138
PRIOUT #: 13-SG- 473693
APPLICATION #: AP429559
DATE PAID: 10/15/2007
FEE PAID: $200.00
RECaxPT #: 13 -P1D- 450735
DOCUMENT #: PR326611
LOT: 8 BLOCK: 3 SUBDIVISION: replattrac
PROPERTY ID #: 11 -3205- 024-0250 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER]
[OR TAX ID NUMBER)
SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION
391.0065, F,S., AND CHAPTER 64E -6, F.A.C. DEPARTMENT 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.
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. [ 1,050 1 GALLONS / GPD Existino septic tank CAPACITY
A [ O 1 GALLONS / GPD CAPACITY
N I 0 1 GALLONS GREASE INTERCEPTOR C"ACiTY IMAxn4um CAPACITY SINGLE TANKi1250 GALLONS)
K E 1 GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps C ]
D E 400 1 SQUARE FEET bed configuration drainfileld SYSTEM
R [ 0 1 SQUARE FEET SYSTEM
A TYPE SYSTEM: [ ] STANDARD { ] FILLED 1X1 HOUND [ 1
I CONFIGURATION: [ ] TRENCH [x] BED [ ]
N
F LOCATION OF BENCHMARK: F.F.E., 8.30°" NGVD,
I ELEVATION OF PROPOSED SYSTEM SITE { 26.40]{ INCHES FT IIABOVE BENCHMARK /REFERENCE POINT
E BOTTOM OF DRAINFIELD TO BE [ 50.4011 INCHES I-T I[AB0VE/ BENCHMARK /REFERENCE POINT
L
D FILL REOUIRED: (42.001 INCHES EXCAVATION REQUIRED: E 24.001 INCHES
0
T
H
E
R
"Driveway in the drainfield area shall be permanently removed, it shall not be placed back"
'Invert elevation of drainfield to be no less than 4.10 ft. NGVD.
'Bottom of drainfield elevation to be no less than 4.60 ft. NGVD.
-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with
sec. 64E- 6.013(3)(f). F.A.C.
SPECIFICATIONS BY: Ca os M Icaza TITLE:
APPROVED BY
DATE ISSUED
TITLE:
�.Q
—�
Dade CHD
s M Lcaza
10,1612007
EXPIRATION DATE: 01/14/2005
DH 4016, 10/97 (Previous Editions May Be Used) Paq® 1 of 3
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33 138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
Permit Type: Plumbing
OCT 3 1 2007,
B Y. - 9-�� .........
Permit No. f(,)m —Oelal 8,
Master Permit No.
Owner's Name (Fee Simple Titleholder)
Phone fl
Owner's Address
CitY_�_' State
Zip
Tenant/Lessee Name Phone#
E-MAIL:
Job Address (where the work is being done)
City Miami Shores Village_ County Miami-Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Conti-actor's Company Name'
-Phone
Contraztor's Address
City State
Qualifier Name
State Certificate or Registration NO.
E-MAIL:
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
—Zip
Phone#
Certificate of Competency No.
Phone #
Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ❑New 10 R epai r/Rep lace F] Demolition
Describe Work:
Submittal Fee Permit Fee $. m5.00 CCF$ On CO/CC
Notary $ Training/Education Fee $_ .0 .40--- Technology Fee $.
Scanning $ Radon $ DPBR $ Zoning
Bond $ 50-an Code Enforcement$ Double Fee $
Structural Review. $ Total Fee Now Due $ 4ql AV
Ca07 -11 Cn _e,_�Cm
W IOU
j
X. See Reverse side -4
-fto
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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. 1 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 must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged
Signature- c y
Signature
Owner or Agent Cnnh ar fnr
The foregoing instrument was acknowledged before me this
day of0C+ 200 , by Y - 1E1- W ro(
who isepersonally know_ n to c-or who has produced
NOTARY PUB
Sign:
Print:
My Commission E
>ti tx� *xx,t,;xxxx *�
As identification and who did take an oath.
NFf�O� EX1yiZ Sept. 14,2009
(407) 898.01 -;, Fkxid® Na" SerAm.gon
APPLICATION APPROVED BY:
(Revised 02/08/06)
The foregoing instrument was acknowledged before e his
day of l ", ��, 20 , by (5 h Y
who is personally known to me or who has produced
as
NOTARY
Sign:
Print: j7�� �
My Com is`401
(407)
f- n and who did take an oath
C:� lio
KEMBLtGEITTRICKJ
`ireSE,`''piR4,2009
F3n;idovice.co iCY�: X1C%X%
Plans Examiner
Engineer
Zoning
B.OUNDARY
. SURVEY
(50' Total Right —of —Way —Line)
.� � .� Centerline's `� � � �•�
.20' Pavement
04 15' Parkway N
Re ord 8c Measure 5. '
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GRAPHIC SCALE
20 0 10 20 40
( IN FEET )
i inch = 20 ft.
' Point of Curvature
LOT 9 BLOCK 3
RECORD= 99.57'
,kpp®VED
Permit 110. A ?_ (6 S "L y 1
Bate: f�' Miami -Dade co=ty
Healydh Depa��
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Residence
1460 NE 102nd Street
2
Y
Lowest Floor
Elev.=-+-8.35'
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GRAPHIC SCALE
20 0 10 20 40
( IN FEET )
i inch = 20 ft.
' Point of Curvature
LOT 9 BLOCK 3
RECORD= 99.57'
,kpp®VED
Permit 110. A ?_ (6 S "L y 1
Bate: f�' Miami -Dade co=ty
Healydh Depa��
,5Z 17� r
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LOCATION SKETCH:
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LOCATION SKETCH:
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LOCATION SKETCH:
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( IN FEET )
1 inch = 20 ft.
�a
n
LEGAL DESCRIPTION: Lot 8 Block 3, REPLAT OF MIAMI SHORES BAY PARK ESTATES, ac
the Plat thereof, as recorded in Plat Book 56 at Page 86 of the Public Records of Dad
Florida, now known as Miami —Dade County, Florida.
SURVEY FOR: GLENWOOD C. EKLUND AND JEANNI EKLUND
1469 NE 192ND STREET
MIAMI SHORES, FLORIDA 33138
I HEREBY CERTIFY: That the SKETCH OF SURVEY of the above captioned property
was completed under my supervision and /or direction, to the best of my knowledge and
This survey meets or exceeds the Minimum Technical Standards set forth by the Florida
of Land Surveyors in Chapter 61G -17 -6 Florida Administrative Code. Pursuant to Secti(
472.027, Florida Statutes. 1/7)
DELTA SURVEYORS, INC. .
13052 SW 133RD COURT
MIAMI, FLORIDA 33186
CERTIFICATE OF AUTHORIZATION
L.B. NO. 3386
STATE OF FLORIDA
305 - 253 -0909
20,' FAX: 305 - 253 -0933
N
..
K
NE 102ND STREET
�a
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LO
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LOCATION SKETCH:
0.
NOT TO SCALE
17
WALDO F. PZ Z D � NED:
)FESSIONAL SURVEY AN MAPPER
NO. 3284
STATE OF FLORID
1)FLOOD ZONE: AE BASE: +9.0' PANEL NO. 0093 J
COMMUNITY NO. 120652 DATE OF MAP: 7 -17 -95
2)THERE MAY BE ADDITIONAL RESTRICTIONS THAT ARE NOT SHOWN ON
THIS SURVEY THAT MAY BE FOUND IN THE PUBLIC RECORDS OF THIS
COUNTY
3)EXAMINATION OF ABSTRACT OF TITLE WILL HAVE TO BE MADE TO
DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING PROPERTY
4)LOCATION AND IDENTIFICATION OF UTILITILIES, IF ANY ARE SHOWN IN
ACCORDANCE WITH RECORDED PLAT
5)OWNERSHIP IS SUBJECT TO OPINION OF TITLE
6)TYPE OF SURVEY: BOUNDARY SURVEY
7)THE HEREIN CAP11ONED PROPERTY WAS SURVEYED AND DESCRIBED BASED
ON THE SHOWN LEGAL DESCRIPTION: PROVIDED MY CI!0T • • • • *00000
8)SURVEY MAP AND REPORT OR THE COPIES THEtq� ARE NOT 'ACID NTHOUT -�HE SIC
AND THE ORIGINAL RAISED SEAL OF A FLORIDA �&JSED SLMrOR AND' 1uhh kR
9)THIS PLAN OF SURVEY, HAS BEEN PREPARED FOR.IHE EXCLU$jj USE - 0t....
THE ENTITIES NAMED HEREON. THE CERTIFICATE-990 NOT'FJ V, M TO ,....
ANY UNNAMED PARTIES •0.6.6 0 00 %60
10)UNDERGROUND UTILITIES ARE NOT DEPICTED HERE(5M : CONX(!T VE
APPROPRIATE AUTHORITY PRIOR TO ANY DESIG14 110AI OR 0 •
CONSTRUCTION ON THE PROPERTY HEREIN DES IBED'. SURVE'n. SHALL• • • : -
BE NOTIFIED AS TO ANY DEVIATION FROM UTILI S'%IOWN FfEREON. �....;
11)THE SURVEYOR OF RECORD DOES NOT DETERMINE OWNERSHIP 0�-
FENCES. MEASUREMENTS SHOWN HEREON DEPICT PHYSICAL LOCATION OF
FENCE
12)ACCURACY: THE EXPECTED USE OF LAND AS CLASSIFIED IN THE MINIMUM
TECHNICAL STANDARDS (61G17 —FAC), IS "SUBURBAN '. THE MINIMUM RELATIVE
DISTANCE ACCURACY FOR THE TYPE OF BOUNDARY SURVEY IS 1 FOOT IN 7,500 FEE
THE ACCURACY OBTAINED BY MEASUREMENT AND CALCULATION OF A CLOSED
GEOMETRIC FIGURE WAS FOUND TO EXCEED THIS REQUIREMENT
13)IN SOME INSTANCES, GRAPHIC REPRESENTATIONS HAVE BEEN
EXAGGERATED TO MORE CLEARLY ILLUSTRATE RELATIONSHIPS
BETWEEN PHYSICAL IMPROVEMENTS AND /OR LOT LINES. IN ALL CASES,
DIMENSIONS SHOWN SHALL CONTROL THE LOCATION OF THE
IMPROVEMENTS OVER SCALED POSITIONS.
14)NO ATTEMPT HAS BEEN MADE TO LOCATE ANY FOUNDA11ON BENEATH
THE SURFACE OF THE GROUND.
15)CONTACT THE APPROPRIATE AUTHORITY_ PRIOR TO ANY DESIGN WORK
ON THE HEREIN DESCRIBED PARCEL FOR BUILDING AND ZONING INFORMATION.
16) ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGI
PARTIES IS PROHIBITED WITHOUT WRITTEN CONSENT OF THE SIGNING PARTY OR PAR
IF ELEVATIONS ARE SHOWN, THEY ARE BASED ON A CLOSED LEVEL LOOP USING THIRD
PROCEDURE AND ARE RELATIVE TO THE NATIONAL GEODETIC VERTICAL DATUM OF 1929
0.0 DENOTES EXISTING ELEVATION
ELEVATION REFERS TO THE NATIONAL GEODETIC VERTICAL DATUM OF
MEAN SEA LEVEL OF 1929
BENCHMARK: B -62 ELEVATION: +8.74'
LOCATOR INDEX: 3250S
FIELD SURVEY DATE: 11 -19 -07 SCALE: 1' = 20' DRAWN BY: Y.F.
DRAWING DATE: 11 -20 -07 FB: SKETCH DRAWING NO.: 07 -0
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1111111111111111111111111111111111111 IN 1111
C ' 00BRO264980 OR OK 26299 F's 27020 Ups)
RECORDED 04/01/2008 01:57.49
This Instg�ment,Prepared e / HARVEY RUVIN? CLERK OF COURTr MIAMI -DADE COUHTYP FLORIDA
Name_ 1/61/I/7�-2.•(��.1� ! A -T ¢'
Address_ 14460 Alfs 40-9. :„ r
Permit No. Tax Folio No.
NOTICE OF COMMENCEMENT
STATE OF
COUNTY OF
THE UNDERSIGNED hereby gives notice that improvement 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
1. Description of roperty: Qegal descnptio of property, and street address If available)
2. General descd 'on of improvement '
3. Owner information /9� V �A i�%"E^
a. Name and address:
b. Interest in property: Q W Mkt
c. Name and address of fee simple titleholder (if other than /own)err))/
4, Contractor. :5 &e �/ qlo fC
a. Name and addres
b. Phone number T �, - -25'9
5. Surety
a. Name and address:
b. Amount of bond $
c. Phone number.
6. Lender
a. Name and address:
b. Phone number.
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes:
a. Name and address:
b. Phone number.
8. In addition to himself, Owner designates the following person(s) to receive a copy of the Llenor's Notice as provided In
Section
713.13(1)(b), Florida Statutes:
a. Name and address:
b. Phone number.
9, Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is
specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A
NOTICE OF'COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATT0?EY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCE,IIAENT. /�
Owner or Owner's Authorized Officer/Director
Signatory's Tt Off"
h trument was acknowledged before me this day ear) by
(name of person) as (type of
authority, ...e.g. officer, trustee, attorney In fact) for (name of party on
behalf of whom Instrument was executed).
1gMWPnUC -STATE OFFLORIDA ,
ro�""'4., � clliLila V. CabUlOs PPflnpe, Notary ublic —State of Florida
=C�lruission #DD717923 r Stamp Commissioned Name of Notary Public
��r ; SEP 23, 2011 Comm�sion Number
we'..•• eBWDUZSeo., S
BMIMgRgu iTt Personally Known _ or Produced Identification -0
Verification Pursuant to Section 92.525. Florida Statutes
Under penalties of perjury, 1 declare that I have read the foregoing and that the fads stated In It are true to the best of my
knowledge and belief.
Signature of Natural Person Signing Above
VILLAGE OF MIAMI SHORES
OWNER BUILDER DISCLOSURE STATEMENT
NAME: G, eAJ f ZT e U DATE:
ADDRESS: AY gzcr - /x;m
Do hereby petition the Village of Miami Shores to-act as my own oontrat for pursuant to the laws
of the State of Florida,. F'S 489.103(7). And I have read and understood the following disclosure
statement, which entitles me to work as my own contractor; I further understand that I as the
owner must appear in person to complete all applications.
State Law requires construction to be done by a licensed contractor. You have applied for a
permit under an exception to the law. The exemption allows you, as the owner of your property,
to act as your own contractor even though you do not have a license. You must supervise the
construction yourself. You may build or'improve a one4amily or two;-family residence. You may
also build or improve a commercial building at a cost of $25,000:00 or less. The building must be
for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a
building you have built yourself within one year after the construction is complete, the law will
presume that you built for sale or lease, which is a violation of this exemption. You may hot hire
an unlicensed person as a contractor. It is your responsibility to make sure the people employed
by you have licenses required by state law and by county or municipal licensing ordinances. Any
person working on your building who is not licensed must work underyour supervision and must
be employed by you,, which means that you must doduct F.I.C.A and with - holdings tax and
provide workers' compensation for that etnplgyee, all as prescribed by law. Your construction
must comply with all applicable laws, ordinances, buildings codes and zoning regulations.
Please read and initial each paragraph.
1. I hold title to the above property and I am planning on doing this construction
Initial
2. I understand that as an owner-builder'! must abide by all zoning ordinances and
building regulations in effect at. the time of permit application
Initial-
.1
3. :I have an understanding of the 2004 FBC & FRC and understand tht this
department and its-inspectors -are there to help enforce and interpret the code.
There is a copy of the code in this office for review.
Initial
4. I understand that the building official and inspectors are not there to design,
alter or give advice on how to meet code —. only if the structure meets the
minimum code.
Initial
I understand that as an owner- builder, that any contractor disputes with sub-
contractors and myself must be handled in a civil court with the advice of an
attorney. The department will not mitigate any contract disputes.
Initial
6. I understand that if I compensate any person or company for work performed
they are required to have a business license in the county. If-for any reason they
do not posses a business license I will be responsible and liable for any wrong
doing from this unlicensed 'company-or person.
Initial £,
7. - T, understand that if any person gets injured on my construction project—they are
entitled to workmen's compensation. And if they do not posses a workmen's
policy Fcould be held liable for all doctor and related cost which could include
loss of wages during recovery from injury.
Initial
8. I understand that. under state and local laws I can not do any Electrical,
Plumbing, Heating, Air & Roof work on my-property with out first obtaining
the proper permits by licensed contractors.
Initial
Was acknowledged before me this ,;2 day f
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BY P.aNNe �G C /dj��i!/b� who was personally known to me or who has
Produced there License or _P7/a A e 41-ex s 21 F C. identification.
:off P%, Notary Public State of Florid
%Y4 Laura Lopez
�aQ W Commission DD586323
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Expires 08/17/2010
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FLORIDA DEPAWWW t
Charlie Crist Ana M. Viamonte Ros, M.D., M.P.H.
Governor State Surgeon General
March 28, 2008
Jeanne & Glennwood Eklund ()
1460 NE 102 St
MIAMI, FL 33138
RE: Contingency Letter
Application Document No: AP852474
Centrax Permit Number: 13 -SG- 910050
OSTDS Number:
1460 NE 102 St
MIAMI, FL 33138
Lot: 8 Block: 3 Subdivision: Miami Shores Bay P,
Dear Applicant:
This will acknowledge receipt of an application dated 03/27/2008 for a permit to use an existing
onsite sewage treatment and disposal system located on the above referenced property.
"Installation of a driveway according submitted site plan ".
There is not sewage flow increase, change characteristics or compromise the integrity or function
of the system.
Prior permit AP- 429559R
If you have any questions on this matter, please call our office at (305) 513 -3459.
Sincerely,
APPROVED
Enclosures Pem2it no.
cc: -Dade C®� Oeer
Health %epa tmem
Dade
NW 1725167th St
OPA LOCKA, FL 33056
V-1 305 513 -3459
Fax 305 513 -3472