158 16th St - Form Board Elevation Cert 7
FORM BOARD ELEVATION CERTIFICATE
Duval County / Clay County/ Nassau County
71 Left copy on site No box
Lot and Subdivision:
DATE: y- (-g -
PERMIT
NUMBER: \ -
ADDRESS:
REQUIRED SLAB ELEVATION ON CITY eleratan10.Aw yfrom unand
OX'h.Above the grade adjacent to
APPROVED SITE PLAN: huRding
ACTUAL ELEVATION OF FORM BOARD OR
GRADE STAKE: oy
SURVEY COMPANY
NAME: Bartram Trail Surveying, Inc.
1501 CR 315, Suite 106
Green Cove Springs, FL 32043
SIGNATURE OF SURVEYOR: (Party Chief)