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Certificate of ~reconstructíon
[This is 0 partial treatment only and not 0 Quoront] or warranty]
PERMIT NUMBER: 0 7Ð 3 - û y ~ 7 f~ ~~ ~
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THIS FORM IS TO BE FILLED OUT
.:'~. BY CONTRACTORJ8UILDER
l5¡ 0 6 E < £c/(o t'f'e r ' C /e.C'c.~'
LEGAL DESCRJPTION: SECTION:
LOCATION OF PROPERTY:
J BUILDER INFORMATION I
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BUILDER NAME
~'?~~Â<
SI~ATURE .
6 - 1/ - 0 7 ß-RT'Ye/<.
DATE 1'TL.E
f [.ลกõiL TRe:..1.TMENT COMPANY INFOR.~}'ATION 1
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SOIL TREATMENT COMPANY NAME
2.5 '1, S · E. ClA y'\o.v sTr -e.e.T
S"\,^At"t: 1 FL .)'1 'ViS'
ADDRESS
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SOIL TREATMENT/OACS LICENSE #
An wo~k w;u don~ in accord~nce with the manufacturer's
specificati~ns and in accordance with all State and federal
laws governing pesticid~ application. A second treatment
Was done on [Date] it>/II /O'Z as per man~acturer's
specification. If the second treatment is not' req~iJed, 3:.
cop., of the product label shall be included with this
Certific3te.
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BLOCK:
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I T~EATMENT INFORMATION j
DATE OF TREATMENT
CHEMICAL USED
CONCENTRATION
GALLONS USED
METHQ,O QF APPUCATIQN(Rodded. Soil Mixed. ETC.}
LUNEAR FOOTAGS OF AREA TREATED" =J
J SECOND TREATMENT INFORMATION I
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DATE OF TREATMENT
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CHEMICAL USED
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CONCENTRATION
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GALLONS USED
~P~Y' '/;anch &-6~LI
METHOQ OF APPLJCATION(Rodded. Soil Mixed. ETC.}
,·'1{5 ~~I-
LJNEAR FOOTAGE OF AREA TREATED
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Pleas. Mote: The City of Port St. Lucie does not gU~rantee or warranty the preconstructjon soil treatment
atte3ted to in the above. The parpose of thi3 document i3 to snow that to the best of this Department's
knowledge, the builder bas sati:fied the requirements ')f the Standard Bailding Code and the One and Two
Family Dwelling Code'tor protectîon again~t termites.