1775 ATLANTIC BEACH DR - DENSITY REPORT HvaLE.NLORIOA 32205
0.225.5305•ww�+.Tu�EIdwm ‘Willai�sT.COM
MAIN pFFjGe:480 EocEw000 AVENUE, UTToII FaE:80
35553 ' FAX:904 OUT,,J FLA•-352.351.438A21.7905
ner PHONE: Pow Si.LuC�813-681-6381
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P$ Si.WO s,GA.-912.57 1 6015 0206 TAMPA,FLA.- d a c{•�
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Control MELBOURNE,FLA.-
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BUILDER • r -
` BLOCK A GALLONS
LOT NO - ' 'CHEMICAL USED
DATE!TIME USED um
1111126111.-- ---...1....---iWe ADDRESS TED : ��
-
TREATED ��Q p���,3Q�
PRE-TREAT SLAB f TP
PREi�--WOOD TREATMENT larINT$TRUCT f EXT BAND �
ARMS 1 DRIVE f WALKS DIRT FILL MONOLITHIC
WASTE
llai
TYPE OF SLAB ® GALLONS USED
FINAL PERIMETER GRADE
RESIDE RESIDENTIAL Ta GE
COMMERCIAL FOOTAGE LINEAR FOO -
CIRCLE ONE SQUAREFOO
FIRS7 f LOOK r LNING AREA f —_-_
GARAGE _
PATIO f PORCH r REAR Q`,
F RONT ENTRY_____
Z V�l 2 Ho un�_
TOTAL
IIIMI
Wilkill"5"11
ED
TEGH r from treatment dale Fam M7080
Annual rene'mal due one(t)Yea
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1
FORM BOARD ELEVATION CERTIFICATE
Duval County / Clay County
«.
LI Left copy on site No box
Lot and Subdivision: 1.4.`N- 37 14‘ v. ;�
DATE: 8-S.-N7
PERMI
I: ER: S \7 - Oo)-t
ADDRESS: \77 5 w 1c $ ssAf,
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN: \330
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: (Party Chief)
..
Bil Ellis&Associates Inc. Corporate ( )
Davis Creek Road,Jacksonville,FL 32256 P: 904 880-0960 F:(904)880-0970
•
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
!f! ellisassoc.com South Daytona,FL 32119
•
Work Order#: 7`t%-i b
REPORT OF IN PLACE DENSITY RESIDENTIAL• Project#: % 'z�‘-.
Subdivision: 4\--+L. c c I•i C -C - Reported'to: Report#:
Unit or Parcel: Location By: Gauge#:
Lot#Block: 3 Date Tested: f
Contractor:
Street Address: l-„!<, �t x=',J-1,c. • f I -'''''' City:
Method: Course: i �.
Material: '> Specific Requirements: -
Pass/ Elev/ Base/LR/ Dry Max.Dry % of Max Moist
Fail/ Location Depth Asphalt/ Density Density* Density %
Retest /Lift Thickness
,"►/[ { `,- ti_
!N} i /�I "7 <-p' .L- l ( 4- 1t /.y `( , I ! /
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*Source of Proctor(Project# and/or Work Order#)
P- Test Meets Specification Requirements F-Test Fails To Meet Specification Requirements R- Retest
1 To Be Completed In Field •
Employee Name
Time Superintendent Printed Name
Start/Stop Travel Standby Job Standby Approval
Superintendent Signature
i
1
i
(Office use)
EA-10(rev.04/16) white copy-office use yellow copy-personal use pink and goldenrod-client use
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