1753 Live Oak Ln Form Board FORM BOARD ELEVATION CERTIFICATE
uval County Clay County
Fl---Left copy on site No box
Lot and Subdivision: Se\Jr.
DATE: OALVIi
PERMIT
NUMBER: 5 I c0 n S ._
ADDRESS: ( 7S 3 LNQ. OC. lJ
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN: ZOO
ACTUAL ELEVATION pF FORM BOARD OR
GRADE STAKE: ; L1(')
SURVEY COMPANY
NAME: Bartram Trail Surveying, Inc.
1501 CR 315, Suite 106
Green Cove Springs, FL 32043
SIGNATURE OF SURVEYOR: (Party Chief)
•
El Jacksonville
7064 Davis Creek Road,Jacksonville,FL 32256 P:(904)880-0960 F:(904)880-0970
Brunswick
134 Newman Drive,Brunswick,GA 31520 P:(912)279-0085 F:(912)279-0086
IIIIII -
ecslimited.com
Work Order#: '
REPORT OF IN PLACE DENSITY RESIDENTIAL Project#:
Subdivision: c -- r 1- Reported to: Report#:
Unit or Parcel: Location By: c— Gauge#:
Lot#/Block: —" Date Date Tested:
Street Address: /7--2, L'V t 44-- l.A c,.‘ City: i-t_, �-c L E 1
Method: Course: T. ` `-"
Material: . I /s,_1,-...--- Specific Requirements: S' v/
Pass/ Elev/ Base/LR/ Dry Max. Dry % of Max Moist
Fail/ Location Depth Asphalt/ Density Density* Density %
Retest 71...L,4,LA,a,4_‘` t , /Lift Thickness
1, 4 t_ I n / , F •) 7 C/7- L
"c. _( \1 7 41 A_- Vt _t(
*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
Standby Approval
Employee Name
Time Superintendent Printed Name
Start/Stop Travel Standby -'Job --__
Superintendent Signature
(Office use)
ECS-10(rev.01/18) white copy-office use yellow copy-personal use pink and goldenrod-client use „_ \ of
Jacksonville,Florida Main Office
®Turner 8400 Baylyeadows Way Ste.12•Jacksonville,Florida 32256-8248
Tn
Pest (904)355-5300.904-353-1488(Facsimile) PRE-TREAT
St.Marys,Ga.•Daytona Beach,Fla.•Melbourne,Fla. LABEL
®Control Ocala,Fla.•Orlando,Ha.•Port St Lucie,Fla.•Tampa,Fla.
Toll Free:800-225-5305•www.turnerpestcocom
BUILDER RVe/ i ' 117/77.(6 PERMIT NUMBER1:1-E.j1
9 0//j
LOT NO. BLOCKSECTION SUBDIVISION
1.-1/6"--64—W-141
ADDRESS1
TREATMENT AREA DATE/TIME CHEMICAL • GALLONS EMPLOYEE
,TTRR/EATEDy� -�`� USED J� USED C
PRE-TREAT SLAB/PORCH/ENTRY 1V J9/Il }- U,[/ _P/5 +oj 393
WOOD TREATMENT 1"� - r *�� )T/ l 1
INT STRUCT/EXT BAND
WASTE ARMS/DRIVE/WALKS
FINAL PERIMETER GRADE
1
CIRCLE ONE COMMERCIAL RESIDENT! TYPE OF SLAB. DIRT FILL MONOLITHIC
S UARE FOOTAGE LINEAR FOOTAGE % GALLONS USED
FIRST FLOOR r LIVING AREA
GARAGE
PATIO I PORCH/REAR
FRONT ENTRY 1/
TOTAL TREATED - 7 _ f 393.
TECH
HO-LBL-0002
Annual renewal due one(1)year from treatment date.
Form#7080