255 W 14th St Form Board Elev Cert FORM BOARD ELEVATION CERTIFICATE
Date Permit Number:
Address:
All American Surveyors Work Order #
Required Slab Elevation on City Approved Site Plan:
Actual Elevation of Form Board or Grade Stake:
11 •Qa
Survey Company:
ALL AMERICAN SURVEYORS OF FLORIDA INC.
3751 San Jose Place, Suite 15
Jacksonville FL 32257 Work Phone: 904-279-0088
Signature of Surveyor: (PartyChief)
LEGACY ' In-Place Density Tests:
ENGINEERING, INC Subdivision / Lot Number: zs3`/7r"- 1/
Geotechnical&Materials Engineering and Testing (Address if no lot number)
Location Lift/Depth % Max Density
-42
yW 4, P"�
The above tests meet the specification requirements — Pass 2 Fail ❑ (if fail,see notes below)
Notes:
This report has not been reviewed by an engineer,
the final report can be found at LegacyReports.com
LEGACY
Date Tested: 3 -//—z / 0
R REPORTS®COM
Tested By: S- e . FAST & EASY ONLINE ACCESS
6424 Beach Boulevard, Jacksonville, FL 32216 - 904-721-1100
f
elVir Call McCMCCall llWe DIt All!� NOTICE OF TREATMENT
a ... o
Applicator Name k'A / "
Address n6 I COI I E S E v,`T
City ►c � l�/ F FL 32265
Date 1 Time V.•6°F/1 y/Dp4W
SITE LOCATION
Lot# Block# Permit#
Subdivision r/iYFK 6:"0-1 y tgcr'V'F`
Address )55 /Y7-j' ST 4//q07// ( 1.51(‘ t f 32'23-
Name of Chemical Applied T ILLIe
i / s( Used 'X25 %
Area Treated Mc/)o///h 1 c 5/4 ,yam
Gallons Used ADO
Remarks y JJ�J
No
Applicator-White Permit File- Canary Permit Holder- Pink