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1781 ATLANTIC BEACH DR - FORM BOARD ELEVATION 1/4 FORM RM. BOARD ELEVATION N CERTi TCA / Left copy on site No box Lot: 3 8 DATE: a,( - /y 17 PERMIT NUMBER: 1 7 S Fia 3 2 7 y ADDRESS: nP1 n-i /Qr )- , c. d«,._ D% -,-- i 1 REQUIRED SLAB ELEVATION ON CITY - } APPROVED SITE PLAN: - /3 3O ACTUAL ELEVATION OF FORM BOARD OR GRADE STAKE: lc) fos SURVEY COMPANY NAME: Bartram Trail Surveying, Inc. 1501 CR 315, Suite 106 Green Cove Springs, FL 32043 SIGNATURE OF SURVEYO Z.: (P Chief) EA Ellis&Associates Inc. Corporate7064 Davis Creek Road,Jacksonville,FL 32256 P:(904)880-0960 F:(904)880-09n EGroup of Companies Branch Location: Geotechnical•Construction Materials•Environmental•Facilities Brunswick: 134 Newman Drive,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086 Daytona: 2706 S.Ridgewood Ave.,Suite 2 P:(386)944-9588 F:(386)944-9589 ellisassoc.com South Daytona,FL 32119 Work Order#: I , REPORT OF IN PLACE DENSITY RESIDENTIAL Project#: `. Subdivision: C Reported to: Report#: Unit or Parcel: Location By: Gauge#: Lot#Block: Contractor: \_ r Date Tested: Street Address: ' ' - .= ( -- City: Method: —+ - Course: i- Material: � Specific Requirements: -c Pass/ Elev/ Base/LR/ �- Fail/ Location De th As halt/ Dry Max. Dry % of Max 1VItt , P P �; �, Density Density* Density Retest /Lift Thickness • - / _. - to *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 Employee Name -- Standby Approval Time Superintendent Printed Name Start/Stop Travel Standby Job st Superintendent Signature (Office use) EA-10(rev.04/16) white copy-office use yellow copy-personal use pink and goldenrod-client use Page—of— _ 8. D < ƒ / $ C0 / / / :3,:, / / ° G 3 3 R § 3 \ \ / / j # % ° ' § • E 3 2 ° ° ° = 7J - z \ ) _ \ 003 fR \ ° - \ k \ e $ \ 9 22 2 / X » — n e � 0_ e Fos E ? e \ n g a \2 2 w J ° & ( i C 2 7 .. .. _ — CD / o \ 2 \ \ \ / 2 < < \ )/ S. \ § - 0 G < \ E Co > \ c « m z e ¥ n E ƒ f co co » I q & J \ , \ O > > r !j_ \ ® rri / § z (� CD ° 0 0 ƒ 7 \ \ v 0 co m / / ƒ m I ƒ « # ® / / e > o • O Cr 0 = J_ \ . 0- 70 ® < 7 m / ul \ _ 0 { C) ? ) n -13 \ 3 % 2 k / 2 ~ ® \ D } Fri co CO /. Co cD /q ƒ c © D -0z 0 z 0 $ / o / : e Cr; / CO m / -0 t -, 5p - m 7' /t \ / / w CT) H 9 Z3 / > / / — z / O 0 » / CO m 0 I 0 0 C Z H 2 4 0 I- C I