1673 Atlantic Beach Dr RES18-0343 form board elevation certificate & compaction report FORM BOARD ELEVATION CERTIFICATE
Duval County / Clay County/ Nassau County
Left copy on site No box
Lot and Subdivision: z0 7- /3 �9 7�a.v 7
DATE: 1Z - z e - s
PERMIT
NUMBER:
ADDRESS: 4.
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN: s
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)
Jacksonville
7064 Davis Creek Road,Jacksor*jlle,FL 32256 P:(904)880-0960 F:(904)880-0970
EE Brunswick
134 Newman Drive,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086
ecslimited.com
Work Order#:
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#:
Subdivision: Reported to: Report#:
Unit or Parcel: Location By: Gauge#:
Lot#Block: Contractor: t �:ti ; Date Tested: 1
c.
Street Address: I .' L r_!, c xt .,:�t ' City: �_ +.
Method: Course:
Material: Specific Requirements:
Pass/ Elev/ Base/LR/ Dry Max. Dry % of Max Moist
Fail/ Location Depth Asphalt/ * /a o
Retest /Lift Thickness Density Density Density
�. \. r ! C
*Source of Profor(Project# and/or Work Order#)
P-Test Meets Specification Requirements F-Test Fails To Meet Specification Requirements R-Retest
To Be Completed In Field ---------------------------------
Standby Approval
Employee Name
Time Superintendent Printed Name
Start/Stop Travel Standby Job
Superintendent Signature
--------------------------------
(Ofce use)
ECS-10(rev.01/18) white copy-office use yellow copy-personal use pink and goldenrod-client use page oJ_