1840 ATLANTIC BEACH DR - DENSITY REPORT FORM BOARD ELEVATION CERTIFICATE
Duval County / Clay County/Nassau County
Left copy on site No box
Lot/Subdivision: Lo-r-5-9 wiz, AJ,z-c
DATE:
PERMIT ( a
NUMBER: i6- F2-isz �--Q
ADDRESS: /era
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN : x'16
ACTUAL ELEVATION OF FORM BOARD OR
GRADE STAKE:
SURVEY COMPANY NAME:
Bartram Trail Surveying, Inc.
1501 CR 315, Suite 106
Green Cove Springs, FL 32043
SIGNATURE OF SURVEYOR: (P., rty Chief)
1 � 4-
I
1
Corporate
EA7064 Davis Creek Road,Jacksonville,FL 32256 P:(904)880-0960 F:(904)880-0970
Ellis&Associates 11C. •
Branch Location:
Geotechnical • Materials Testing • Environmental • CEI Services Brunswick: 227 Rose Drive,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086
Integrated Engineering Services
ellisassoc.com
Work Order#: • ,
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#:
Subdivision: ,- k- ` Reported to: -- Report#:
Unit or Parcel: _ Location By: C I --7 Gauge#:
Date Tested: ' L.
Lot#Block: C`( Contractor:--'Q'Ni `' '
Street Address: t' '!w /-1-7 L > a- i' ``5," City: "
Method: - ''..'( Course: C- '
Material: , r'` Specific Requirements: `'%C '
Pass/ Elev/ Base/LR/
Fail/ Location Depth Asphalt/ Dry Max.Dr*y % of Max Moist
Retest /Lift Thickness Density Density Density %
v -7
/`' -,e -71/ (f' ,1', ----I - ,'7 / "-;'c
*Source of Proctor (Project# and/or Work Order#)
P Test Meets Specification Requirements F - Test Fails To Meet Specification Requirements R- Retest
To Be Completed In Field
Standby Approval
Employee Name
Time Superintendent Printed Name
Start I Stop Travel Standby Job
Superintendent Signature
(Office use) /
EA-10(rev. 11/14) white copy-office use yellow copy-personal use pink and goldenrod-client use
Page of. i
1