HomeMy WebLinkAboutCERTIFICATE Setback 225 Curry Dr 2020-12-10Estes Valley
Setback Certificate
Revision Date: December 2012
Date: ________________
Project Description: _ _________
Project Address: _____________________________ Building Permit Number: ________________
Legal Description and/or PID: __________________
I, ____________________________________, a duly registered surveyor in the State of Colorado,
hereby certify to the following:
A survey of the foundation wall forms for the structure referenced above was performed under my
responsible charge on ______________, 20__.
The result of this survey showed:
NOTES:_________________________________________________
_______________________________________________________
SEAL
The outside of the foundation wall forms are ______feet from the nearest property line; and,
Pick a. or b.
_____a. The foundation wall forms comply with the approved site plan
_____b. The foundation wall forms do not comply with the approved site plan
Company Name
Mailing Address
Phone and email
________________________________________Print Name of Surveyor
______________________________________
Surveyor’s Signature and PLS Number
38424
12-11-20