1728 MARITIME OAK DR - SOIL DENSITY FORM BOARD ELEVATION CERTIFICATE
Duval County / Clay County
Left copy on site No box
Lot and Subdivision: Le-7- ! -I 4 --0" c Ac « " 2
DATE: 11 1y -16
PERMIT
NUMBER: \(o S 2--a%
•
ADDRESS: 17 11)
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN: ( / qo
ACTUAL ELEVATION OF FORM BOARD OR
GRADE STAKE: .o`1)
SURVEY COMPANY
NAME: Bartram Trail Surveying, Inc.
150,1 CR 315, Suite 106
Green Cove Springs, FL 32043
SIGNATURE OF SURVEYOR: (Party Chief)
FLORIDA 32256-8248 T.COM
225.5305• RROAwww
ICE:8400 BAYMEADOT"IS WAY,SUITE 12•JACKSONViLL ,
TOLL FREE:8�"
MAIN O FAX:904.353-140• FLA.-352.351.4386
Turner PHONE:904355-5308 OCALA, FLA.-772-621.7905
912.576-1300 PORT$T�I.UCIE, 1.6361
'""Pest ST.MARTS,EAC" 3M-615.0206 TAMPA,FLA.-813 68
Ol O -1OHA BEAFNAF-321-951.3325
rCo 1 tr ELBOURNE, _ PERMIT NUMBER
� �p� �I -�A` SUBOIVI ON vV SECTIO ! t-.- EMPLOYEE
BUILDER t• OCK Alb- - GALLONS x
4-10' CHEMICAL ® USED
ADDRESS
��� DATE 1 TIME USED �1
TREATED �
si
r�
PRE
.TREAT SLAB 1 PORCH I ENTRY ��or 110111111111111111111111�.��
1 .ppp TREATMENT
I-
INT
STCT 1 EXT IVE I
RIVE I WALKS MONOLITHIC
WASTE ARMS I D DIRT FILL
RAGE OF SLAB rim
GALLONS USED
RIMETER G NTIAtTYPE FINAL PE RESIDE TAGE COMMERCIAL FOOTAGE LINEAR FOO
CIRCLE ONE SQUARE FOO
IIIIIIIIIIIIIIII
r LIVING AREA_,____
REA -
FIRST FLOOR i _
la
GARAGE _----- 11-41111
��PATIO r PORCH r REAR .it _ HO LB4�2
1 FRONT ENTRY __J'`—l 111111161111P/Tis
TREAT ` Form 0080
TOTAL ,
TECH • eo��rl,o�e^Idate Annual ren j
J
Corporate
7064 Davis Creek Road,Jacksonville,FL 32256 P:(904)880-0960 F:(904)880-0970
cm Ellis&Associateslnc. Branch Location:
Geotechnical • Materials Testing • Environmental ■ CEI Services Brunswick: 227 Rose Dri e,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086
integrated Engineering Services Daytona: 2706 S.Ridgewood Ave.,Suite 2 P:(386)944-9588 F:(386)944-9589
South Daytona,FL 32119
ellisassoc.com
Work Order#:
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#:
Subdivision: r-7 t ',--i r- c I- ( c Reported to: Report#:
Location By:
Gauge#:
Unit or Parcel:
Date Tested: '` �-
Lot#/Block:_ !I / Contractor:
Street Address: i - /• 1.---, , -T r,=.-f c F t ,i City: \►- --
Method: --t Course: i t
Material: , Specific Requirements:
Pass/ Elev/ Base/LR/ Dry Max. Dry % of Max Moist
Fail/ Location Depth Asphalt/ Density Density* Density
Retest /Lift Thickness
.t-
Z. 1, V.
*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
i Employee Name
Time Superintendent Printed Name
Start/Stop Travel Standby Job
Superintendent Signature
(Office use)
EA-10(rev.05/15) white copy-office use yellow copy-personal use pink and goldenrod-client use Page of