1769 ATLANTIC BEACH DR - FORM BOARD FORM BOARD ELEVATION CERTIFICATE
11/4/erjGoP� .Au j Duval County / Clay County/ Nassau County
Left copy on site n o
j7 ? 41/a,� 1,c &`i or Nibl' _ 'boo 7
Lot and Subdivision: �j ��� -��� /q1) (Qc /-7.1r
DATE: 3/2p ZOK
PERMIT
NUMBER: AO
ADDRESS: IV AJ /+
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN: T.(Po
ACTUAL ELEVATION OF FORM BOARD OR
GRADE STAKE: I ,')23
SURVEY COMPANY
NAME: Bartram Trail Surveying, Inc.
1501 CR 315, Suite 106
Green Cove Springs, FL 32043
SIGNATURE OF SURVEYOR: (Party Chief)
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