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FORM BOARD ELEVATION CERTIFICATE
Duva County / Clay County
Left copy on site F-1 No box
Lot and Subdivision: 113 WAN11( WO COUNTY LLU8
DATE: 1 /1117
PERMIT
NUMBER
ADDRESS: MARZTZME OAK U
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN: I • �C
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/ �,(Y/"R (Party Chief)