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PL-16-511 y Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone:(305)795-2204 Fax: (305)756.8572 Inspection Number INSP-253527 Permit Number PL-2-16-511 Scheduled Inspection Date.April 1%2016 Permit Type: PlumbingResidential Inspector Hernandez,Rafael - Inspection Type: Final Owner N©UYEN,HA THIEN Work Classification: Drainfield Jab Address:138 NE 108 Stmt Miami Shores,FL 33138- Phone Number (786),318-4784 Project <NONE> Parcel Number 1121360050050 Contractor. AFFORDABLE SEPTIC SOLUTIONS LLC Phone:(305)7264022 Building Department Comments REPAIR DRAIN-FIELD. Infrecuo t808ed UaWents INSPECTOR COMMENTS False Inspector Comments Passed HRS APPROVAL IN FILE Failed El Correction Needed Re-inspection Fee No Additional Irons can be scheduled until re4rispection fee Is psle. o Miami Shores Village 10050 N.E.2nd Avenue NE ty Miami Shores,FL 33138-0000 Phone: (305)795-2204 „ , ry1112t >3 Expiration: 08/28/2016 Project Address Parcel Number Applicant 138 NE 106 Street 1121360050050 HA THIEN NGUYEN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell HA THIEN NGUYEN 138 NE 106 Street (786)318-4784 MIAMI SHORES FL 33161- 138 NE 106 Street MIAMI SHORES FL 33161- Contractor(s) Phone Cell Phone Valuation: $ 2,000.00 AFFORDABLE SEPTIC SOLUTIONS LI (305)726-8022 Total Sq Feet: 1300 Type of Work:REPAIR DRAIN-FIELD. Available Inspections: Type of Piping: Inspection Type: Additional Info: HRS Approval Bond Retum: Final Classification:Residential Scanning:3 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# PL-2-16-58805 CCF $1.20 02/25/2016 Check#:245 $616.70 $50.00 DBPR Fee $2.25 DCA Fee $2.25 02/24/2016 Cash $50.00 $0.00 Education Surcharge $0.40 Bond#:2994 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $666.70 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 ify that all th foregoin information is accurate and that all work will be done in compliance with all applicable laws regulating constructio nd zo ing. but rmore,I a horize the bove-named contractor to do the work stated. IR J March 01,2016 Authorized Slgnat re:Owner / Applicant / Contractor / Agent Date Building Department Copy March 01,2016 1 Miami Shores VillagecRT�= . Building Department artment 24 016 ` MM N.E.2nd Avenue,Miami Shores,Florida 33138 FBY.- ` Tel:(305)795-2204 Faw(305)756-8972 INSPECTION UNE PHONE NUMBER:(305)762.4949 BC 20 (q BUILDING Master Permit Na�c-5 PERMIT APPLICATION Sub Permit No. r-JBUILDING ❑ELECTRIC r--j ROOFING E] REVISION ❑EXTENSION ❑RENEWAL &PLUMBING E]MECHANICAL M PUBLIC WORKS F-1 CHANGE OF F-1 CANCELLATION E] SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1E IM S+ City: Miami Shores County: Miami Dade Folio/Parcel#: L21'S=il'E2t om Is the Building Historically Designated:Yes NO Occupancy Type:�J Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): (l3E IC-�3_ Phone#:-1 S&"��Q.Yy")3,4 Address: I'V�' fsX 1 u n `� _ City: CVQ� ��-t� l i 1 i State: i f Zip.,3Ito to Tenant/Lessee Name: Phone#: Email: c�_r .�} CONTRACTOR:Company Name: . D�1c 14` s Phone# Address:�1_j City:Q��;lit^. 1b State: Zip: Qualifier'Name: t- i )i� iC3 f`•� Phone#: ;-� 7 t State Certification or Registration#: Certificate of Competency 2 V I 1-13c DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Zuncx--> Square/Linear Footage of Work: ( (13 �-)- Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru We: Submittal Fee$ Permit Fee$ CCF$ J c0/CC$ Scanning Fee$ �' C Radon Fee$ -2- DBPR$ o) Notary$ ,,��cc Technology Fee$ f � Training/Education Fee$ ®' Double Fee 1C1 Structural Reviews$ Bond$ � TOTAL FEE NOW DUE$1 [Co (Rev1wW2/24/2014) • 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. 1 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,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$250,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 a d and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 f n ,by i�� day of FiCb ,20 by o U t I Ha7�r►who is personally known to 7� '� d— ,who is personally known to 1J I me or who has produced 11�0 L as me or who has produced L-4 L, as Identification and who did take �r � on and who did to NOTARY PUBUC, L. BUG SCA L.ARMS • P -����� Notary Puelic-Stated Commission#F FF 197889 ,y r of FRIoft w �•°• My Comm.Expires Feb 9.2019 ,,, o. Commission a FF 197489 arose% �''�iio� '�,• My Ct'�nm F ,,; •'s Feb Q.2019 Sign: Print: iLCC.2icc Z. r.ro+�}.- �� Print: i Seal: Seal: **************************** ******************************************************************************* APPROVED BY Plans Examiner Zoning Structural Review Clerk (Reasedo2/24/2014) Or REffSEPTIC TANK CONTRACTOR � DURA D. -BRYANT 1601 NW 175 ST i MIAMI, FL 319�- } AFFORDABLE S'EPTiC SOLUTIONS LLC Business Authorization: SA0141879 SR0141734 Registration`Expires on September 30, 2016 0$841 5 3 3+a C , i,. 88C4T1Y814 fuPAYMBMdRu ecT�t T TAX SO LLC OR x 5.00 tl /28/26'fi5 h ax.The feudal ease, --Hn oft Iffico Hal gov t ul the s N0.ab be an all oo aeralel' as—M elt 01/28/2013 12:01 FAX 6]002 .r7)jflp CERTIFICATE OFlwrif-ifaDnrvYw) -, LlABIl.lTY INSURANCE � I 0211712016 THIS oERTUs1Cfii*ii l-"UED A$A MATTER Op iNFORMATION ONLY AN6 6C-NiiR9 NQ likl i i UPO(V Tt:iE dER77FICATE HOLDER.THIS CERTIFiCATS DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW- THIS CURTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{8),AUTHORIZED i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, fiNFORTANT: If tha oertNleaat holder an Aef0IT*M0'Z NOWED,tncaft I .— — _ _ - — tht ton%and coru011ons of tht ptrltay{Iw)must t»endorsed, if 81lBROOATIQN 13 YItAIVEb,a<tbJict tti --— -- pnor cert n poflf:ke may regaht an endor�mant, A staten od on thio Wfdfk:ate doss tat aoefer r'shfs to the asrtt _boitler In Itaa of such endorsanatlt(e). I CA�iTACT -- . ..._.. _ e — —, -_. RENbA V SOLOMON Affinity Insuranou Group f -- --• •— _.. i 4 E (954)965.3899 i FATS ! 6106 Miramar Pal rkny •- -_1 (AA No): 1954)965.5586 _ �. AReas: __.afdn!Vlr&ursnreftf�mall.oxn Miramar,FL 33023 -_ _ .. -- _ atBUREg{�AFFORDING 4Phon985.556 e {954 985.3988 Fax 9134 6 CQVERIIGE - ...... ..�.__ Nnlc r_•., .. own' �-• - _ . p�9ur;en A-WESTERN WORLD INSURANCE GROUP AfFCrdBbie Septic SOltrfiorl6,D/B/A DURA BFiYANT •-" --- -• -•+ ( 1601 NW 175TH STREET MIAMI GARDENS_ _ Fd. 331f►9ReR E. 'cERT1Ft - — _ CATS NUMBER: _REVISION NUODM- _ i THIS A TO. No-r+Y THAT 11iE PO Ny R OF I EMr=ANCE USTEf}gt3LOW HAVE BEL;N IS$UED f Q TH6 UtSURED NAMED ABOVE FQR ThfE t'dLICY isERIOD IN R AFI ED. NMAY BE IS ANDING ANY RE RTAl �pIT,TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 WHICH TW18 EXCLUSIONS ATB MAY BE ISSUED OR MAY PEltTAlN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN JS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDRIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAtD CLAIMS, TR _ TYPE OPINAN4 I C] TYPE GENERAL LUNLRY Y Nu1FBlR cLAUNfPf$ ,� f a_1 000,000:00 te Iwwt Ll jnaE To RENTr� _ _ ' I❑ � I PRE.M18E8tE�rrara®)..' $.1001000100 IA _- . ...._ . -. . . ... I NPP1386261.01 01310412015 08!0412016 "tEO E��ya or:a para:) si 5,000.E I PERSONA.&ADV INJURY = I.OQO,OOQ.�t) QEML AGGREGATQ LUT APPLIES POR; ( I ."RAL AGGREQATE S 1,000,000.00 ! ( I PoucY ❑ ❑ Loc I J (� CSR I ` I PROO}1CTS.COMPIOP AbG i S 1,0t)O,000.00 (C MEI ED SINIk UMiT—' I fI❑ ANYAUTO l t — — I El fiCH PULED I 1 I J BODILY INJURY(Por psr;p�) ❑ -09MOD HRED AUT08 I — R E . OCCUR11*] LlVWUUALUW­n — LEACH OCCURRENCE_ a A13GRREGATE s __E.•E,_7 DED •.�—.• -- _�. rice rsNTIO�,._._. __.• •--.. __._ .. _ q AN EMPLOY I.LA rIY YIN I r I----••__. ��i BTATLITE ...n EUik, pROPR1ETDRtPAR111>fiR:fi%E J f I t� r >:RIMt Me DtCauD6D7 NIAInmoI I I E.R.EACHACCIDENT _- =ba undw I ll Dr asE-EA EMPLOY S DEBDRIP rION 6F OPERATIONG t+etew— I EL.D1aFASE-POUCYLltrrr, 5 I ADEDUC7I13LES-EACH OCC NPP1385261-01 08104/2015 08!04/2016 1,000 � oeBCIdP'r10N OF o�RAT1ON8!LOCATIO�r9 r yQN�tAf��AGOrtD 701,Addfac+gl)RuMltrl�y —' —•— >IalrWuNr,Iraw"seps"4 requ:rem I STATE OF FLORIDA-LICENSE#380141734 AUTHORIZATION IMA141879 I I j IibiT)F36ATE HOLDER -- — ' - CANCELLA7ION -._.._. ... -.__... _. . MIAMI SHARES VILLAGE SHOULD ANY OF THE Aoovg DESCRLggo POLICIES ISE CANCELLED BEFORE THE EXP77 [RgA ON DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT A E WITH THE POLICY PROVISIONS, i 10050 NE 2ND AVENUE MIAMI SHORES VILLAGE,FLORIDA 33138 REP — - -_ ACORD 25(201"1)QF ®79138.2x14 ACORG CORPORATION. AR rights reserved. The ACORD name and logo aft registered marks of ACORD PERMIT #: 13-SC4659726 STATE Or VLORIDA t a>as4eaRTa�NT OF EZALTH APPLICATION #:AP1224180 ONSITE SXIM= TREATM17.' AND DISPOSAL DATE PAID: SYSTM FEE PAID: STRtTCTION PERMIT RECEIPT #. Docm=T #: PR1004767 CONSTRUCTION PERMIT Fox: OSTDS Repair APPLICANT: Nguyen HabW PROPERTY ADDRESS: 138 NE 106 St Miami,FL 33161 N LOT: 5 BLOCK: 201 SUBDIVISION: PROPERTY ID #: 11-21364X)5-0050 [SECTICN, TOWNSHIP, RANGE, PARCEL NO MM3 [OR TAX ID NUMMMI SYSTEM MIDST BE CONSTRxTCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARSMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMMNCE FCR ANY SPECIFIC PERF OF Tnm. ANY CHANGE IN MRMZRIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH DlODIFICATICNS )W RESULT IN THIS PERMIT BRING MUDE NULL AND VOID. ISSUANCE OF THIS PERMIT. Dogs NOT EXEMPT THE APPLICANT FROM COMPLIANCE_ WITH OTHER FEDERAL, STATE, OR LOCAL PBRMITTING Fx&mam Fm DrAmOSMEOT OF THIS PROPERTY. SYSTEM DE8xQW AND. SPECIFICBTIONS T [ 900 I GALLOWS / GPD new septic tank CAPACITY A [ 0 I GALLONS / GPD CAPACITY N [ 0 ] GALLONS GREASE n42ZRCNPTM CAPACITY Do== CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GiALLous DOSING TANK CAPACITY [ IGALLONS ii[ ]DOSES PER 24 HRS #Pumps t I D [ 300 ] 801AWFEET new bad contig.drainf W SYSTEM R [ 0 ] SQUARE FEET I SYSTEM A TYPE SYS'T'EM: [XI STANDARD.. [ I. F=LT [ ] DKDUND [ ] I CONFIGURATION: [ l TRBNCH tXl HED t I N F LOCATION OF BENCHMARK: FFE 12.34'NGVD I ELEVATION OF PROPOSED SYSTEM SITE t 23.207 INCHES FT ]i ABOVE BxxcmmwazPzRzNcz POINT E BOTTOM OF DRAZNB'IELD To BE [ 45.20 I IIJCHES FT l t ABOVE BENCmwx/REFERENCE POINT L D FILL. : t 0.003 z s EXCAVATION. : [ ] ncm 0 l Ansfall a 900 gal min.Septic tank with an approved filter. 2.-The licensed Contractor inStalling the syStem is responSible for installing the minimum dory of tank in accordance T with s.64E-6.013(3X:),FAC. H 3.4nstall 300 sf of drainfWd in bed configuration OR(ALL AVAILABLE SPACE). 4.4mrert elevation of drainfield to be no Iess than g.OT NGVD. _ E 5.-Bottom of drainfWd eievation tD be no less than 8.5T NGVD. R (Commerrts Continued on Page 2.) SPECIFICATIONS BY: Affordable Sept TITLE: APPROVED BY: TIMM: Engineering Specialist II Dade COD DATE ISSUED: 02/12/2016 EXPIRATION DATE: 05/12/2016 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Page 1 of 3 Incorporated: 64E-6.003, FAC v 1.1.4 AP1224100 SE985103 AFFORDABLE SEPTIC SOLUTIONS LLC 14261 N.W.24TH AVENUE MIAMI FL 33054 (786)580-6729 Date: State of 0 County of (tel ICcc)'I TI)dc Before me this day personally appeared �� hl-Lo+ who being duly sworn, deposes and says: That he or she will be the only person working on the project located at Sworn to (or affirmed) and subscribed before me this �_ day of ('n0(C'�'l 20lam, by Personally known V Or Produced Identification Type of Identification Produced MIN . . 0 IFF FO 9. Print, Type or Stam ry •••. .� Miami Shores Village Building Department �OR>� 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. §440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate rate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if 1. The officer owns at least 10 percent of the stock of the corporation, in the rp �or case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records ecords of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore.you may be personally liable for the worker compensation iniuries of any person allowed to work under this permit. Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. er Contractor Print Name: Print Name:�,j t2� Signature: AlSuqa•-rhSignature. State of Florida) State of Florida) County of Miami-Dade) County of Miami-Dade) Sworn to and subscribed before me this `LS Sworn to,3nd subscribed before�}e this. _ day of % ,20-( _, day of 201eZ . By By (SEAL) (S ) Type of Identification Type of Id rodu Notary Public-S7Flb9 ord pow _Stye F cmc Cor+miss,,.. a89 ' 'My " 2019 eft C01/►FR 181538 My Comma.Expires Fab 8,2519 �' t (0 -s l 1 APPLICATION #:AP1224180 PERMIT #:13-SC-1659726 STATE OF FLORIDA DEPARTMENT OF HEALTH DOCUMENT #:F11047494 ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM DATE PAID:03/29/2016 CONSTRUCTION INSPECTION AND FINAL APPROVAL FEE PAID:55.00 RECEIPT #:13-PID-2916229 APPLICANT: Nguyen Hathien AGENT: Affordable Septic PROPERTY ADDRESS: 138 NE 106 St Miami, FL 33161 LOT: 5 BLOCK: 201 SUBDIVISION: ID#: 11-2136-0054050 CHECKED [X] ITEMS ARE NOT IN COMPLIANCE WITH STATUTE OR RULE AND MUST BE CORRECTED TANK INSTALLATION SETBACKS I I [01] TAKE SIZE [l] 1090.00 Ill t ] E271 SURFACE WATER FT Polyethylene [ ] [281 DITCHES FT ( I 1021 TANK MATERIAL [ ] [031 OUTLET DEVICE I ] [29] PRIVATE WELLS FT [ ] [04] MULTI-CHAMBERED [ Y N ] ( ] [30] PUBLIC WELLS FT [ ] [05] OUTLET FILTER Tuf-rite EF-4 [ ] [311 IRRIGATION WELLS 25 FT ( ] (06] LEGEND 1. 70-143-11DC3 2. [ I [32] POTABLE WATER 24 FT t ] 1071 WATERTIGHT [ ] [33] BUILDS FOUNDATIONS 5 FT [ ] I08I LEVEL I ] 1341 PROPERTY LINES 5.5 PT-- L l FT [09] DEPTH TO LID t ] [35] OTHER DRAINFIELD INSTATLATION FILLED / NO= SYSTEM [ ] [101 AREA Ell 300 _ [2]_ SQFT ( ] [361 DRAINFIELD COVER [ ] [11] DISTRIBUTION BOX HEADER X I 1 1371 SHOULDERS [ ] [121 NUMBER OF DRAINLINES 1. 5.00 2. [ l [38] SLOPES [ ] [13] DRAINiLINE SEPARATION ( ] [39] STABILIZATION [ I [14] DRAINLINE SLOPE I I 1157 DEPTH OF COVER ADDITIONAL INFORMATION [ ] [16] ELEVATION [ ABOVE / IBM 56.16 [ I 1401 UNOBSTRUCTED AREA ( ] [17] SYSTEM LOCATION [ ] 1411 STORM11ATER RUNOFF [ ] [18] DOSING PUMPS [ ] [42] ALARMS [ I [19] AGGREGATE SIZE [ I [43] MAINTENANCE AGREEMENT [ 1 [20] AGGREGATE EXCESSIVE FINES [ 1 [44] BUILDING AREA [ ] [21] AGGREGATE DEPTH [ ] [45] LOCATION CONFORMS WITH SITE PLAN FILL / EXCAVATION MATERIAL [ ] [46] FINAL SITE GRADING ( ] (47] CONTRACTOR Affordable Sept(Affordable [ ] [22] FILL AMOUNT [ ] [48] OTHER ADS ARC 24 [ ] [23] FILL TEXTURE [ 1 (241 EXCAVATION DEPTH ABANDONMENT I I [251 AREA REPLACED ( ] [49] TANK PUMPED 03/18/2016 I 1 [26] REPLACEMENT MATERIAL I I [501 TANK CRUSHED 6 FILLED 03/18/2016 Comments: Comments are on page 2. Dade CHD DATE: 03/18/2016 00NSTRUCTION [ APPROVED / DISAPPROVED ]: Emiron"nW SpecWist U Hebra.Montero(Deparbnent of Health 1QDacb?C FINAL SYSTEM [ APPROVED / DISAPPROVED ): Dade DATE: 04/04/2016 (&$planation of violations on following Page) DH 4016, 08/09 (Obsolete$ all previous editions which may not be used)Florida He It 18 i-Dad%�tknt)t 3 Incorporated: 64E-6.003, FAC ElDi658?•l6'S•�D. ell Program EH Database v 1.0.1 AP1224180