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Port St. Lucie Building L_..spartment
This form is to be filled out
by Pest Control Company
Certificate of Compliance
(This is a partial treatment only and not a guarantee or warranty) SCAN tlEU
Permit Number: /L5y (_ ' D S~ stW �
Location of Property: / ?� l/ i� S % ��`p % %�i�- 9
Legal Description: Section Ft,,q (_3 Block
Pest Control Company
Compan r - Print
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Date Title
Soil Treatment Company Information
14V2/WCAA/&' A�5)(7'61 s I,&0U3 DC..
Soil Treatment Company Name
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Addc ress
Soil Treatment/DACS License #
The building has received a complete
treatment for the prevention of
subterranean termites. Treatment is in
accordance with the rules and laws
established by the Florida Department of
Agriculture and Consumer Services. A
second treatment was done on (date)
as per manufacturer's
specification. If the second treatment is
not required, a copy of the product label
shall be included with this certificate.
Lot
Treatment Information
�,)1�-
DaN off Treatment [�
Chemical Used
ja to
Concentration
Gallons Used
Method of A plication (s i cced, etc.
Lim ;06 of Area Treated
Second Treatment Information
Date of Treatment
Chemical Used
Concentration
Gallons Used
Method of Application (soil mixed, etc.)
Linear Footage of Area Treated
Please Note: The City of Port St. Lucie does not guarantee or warranty.the preconstruction
soil treatment attested to in the above. The purpose of this document is to show that to
the best of this department's knowledge, the builder has satisfied the requirements of the
Florida Building Code for protection against termites.
This form MUST BE RETURNED to the Building Department
before your final inspection is scheduled!