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City of Wheat Ridge Municipal Building 7500 W. 29"' Ave. Wheat Ridgc. CO 80033-8001 P: 303.235.2846 F: 303.235.2857
FOUNDATION SETBACK AND ELEVATION CERTIFICATION
This form, including the Exhibit on the reverse side, must be fully completed by a Professional
Land Surveyor licensed in the State of Colorado. This Certification must be submitted for review
and approval prior to the placement of concrete and before proceeding with any further
construction..
DATE: / Le, /
PERMIT# '� C - c�
ADDRESS: S % Lj -j 12v4&'
r rrL�� : "?
3,6�'IC-1nJ SUBDIVISION
LOT 2, , BLOCK /V t
I hereby certify that the elevation and location of the recently constructed structural foundation
for the above property described above has been measured by me or directly under my
supervision. The foundation setbacks and elevations for all recently constructed building
corners as stated herein have been found by me to be in compliance with all civil engineering
and Building Permit construction plans as approved by the City of Wheat Ridge.
The MINIMUM SETBACK DISTANCES from the property lines have been determined to be:
FRONT: Nk;( 0?4 0 REAR: 5 t=a i SIDE: a Fe`TsT SIDE: U r-6! 7� l
The MINIMUM ELEVATION has been determined to be: 1✓ F � .5440. 1 (NAVD88).
The above measurements have been determined on the following location:
Check only one):
The setback
Signed
Top of proposed foundation prior to placement of concrete
Top of foundation subsequent to placement of concrete
measurement locations are identified on the attached exhibit.
Print r�/��f�+ E/Vl �� Date
Professional Surveyor
�0�-,��.R::d I��^ �•� FOR OFFICE USE ONLY
Approved by:
3
r,93 a ; Inspector Dale
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EXHIBIT
N90'00'00"E
112.84'
LOT 2
9,730 SF
0.2234 AC
66.4
0
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N
45.8'
N
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7391 WEST 38TH AVENUE Ln
FOUNDATION ONLY I
FINISH FLOOR=5440.51
5440.50(PLAN)
S89'38'24"W
112.54'
N
cD
WEST 38TH AVENUE
j N0'I'ICETOSURVEYOR:
1. Elevations shall he shown for ALL foundation corners.
2. Foundation corners with minimum elevation and setback distance shall be identifjed.
3. Drawing Waist be properly oriented (North = top of page).
4. Show the roadway in front of the property.
j. If drawing is to -scale, provide the scale. If not to -scales -how as N.T.S.
Rev 09117
0.5'
0.5'