372 10th St Form Board Elevation Cert/Density Test Results FORM BOARD ELEVATION CERTIFICATE
DATE: r--', b. z-? Zo z7-
PERMIT zPERMIT
NUMBER: R C S Z 1 - o z 3 -7
ADDRESS: 97Z lo'' Sfiu �
LoY 33 plod r2 pl4+ /V. l S bd, :r:o ! fIPrN�-c {�ench
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN: 9. 4-
ACTUAL ELEVATION OF FORM BOARD OR
GRADE STAKE: 1cf ,,f r— R4-
SURVEY COMPANY
NAME: Sr��ma.esJr. 4l �.
lv z✓32 LZ- - n.. � cST/i 7:oN Co�.-� FJf' Gl...:{ 'z-
SIGNATURE OF SURVEYOR:
LEGACY i In-Place Density Tests:
ENGINEERING, INC Subdivision/Lot Number: zn .tom Y SA
Geotechnical&Materials Engineering and Tesfing
(Address ifno lot number)
Location LiffDe th %MaxDensi
S
The above tests meet the specification requirements—Pass ❑ Fail O Ortu1,.notes below)
Notes:
This report has not been reviewed by an engineer, LEGACY
the final report can be found at LegacyReports.com
Date Tested: Q » REPORTS-COM
j Tested By: gtg[ El
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