Geotechnical Investigation Info Form

P.O. BOX 60791 • HOUSTON, TEXAS 77205
TEL: (281) 441-1462 • FAX: (281) 441-2367 • EMAIL: info@lshtesting.com
GEOTECHNICAL INVESTIGATION INFORMATION FORM
Date:

MonthDayYear
Date
Quote No.:
to be filled out by LSH
Job No:
To be filled out by LSH
LSH CLIENT:

Report will be addressed to the client
Client Name:
Contact Name:
Address:
If to be mailed to a P. O. Box, a physical address is required for our records
Phone No.:
Cell No.:
Fax No.:
Info Release Authorization

ClientContractorArchitectStructural Engr.Other
Report Distribution

ClientArchitectStructural EngrContractorOther
Please provide name and email or mailing address for distribution
PROJECT INFORMATION:
Structural Information:
Type & Quantity of Structure(s)
No. of Stories
Overall Dimension
Length x width
Eave Height
Square Footage:
Total Sq FootageLivingCoveredSlabOther
Frame :

WoodSteelOther
Exterior:

BrickStuccoBlockHardiPlankTiltup WallOther
Intended Foundation Type:
Structural Loads:
Column lbs
Wall lb/ft
Addition: (Y/N)
If yes , # and size
Existing Structure
# of Stories
Foundation Type
Garage

YesNoDetached
If yes :
# of Stories
If yes :
Distance from Residence
If yes :
Sq. Footage
Parking Lot Subgrade Recommendations Required

YesNo
If yes:
Dimensions of Parking Lot(s)
Jobsite Information:

If unknown, provide street name & distance from nearest intersection
Physical Address
City:
County:
Within City Limits

YesNo
Legal Address:
Brief Directions to site:
For sites not easily located on map or internet sources
Key Map #:
Site Plan Provided

YesIf No, please provide rough sketch or set backs (facing the site from the street)
File Upload

Cancelof
Set Backs to Structure

FrontRearRightLeft
Please explain Set Backs
Building Area Staked

YesNo
Site Conditions

ClearedWoodedUnderbrushConcrete
Site Accessible by vehicle

YesNo
If Any Clearance Restrictions
Please explain
Site Features

WaterSlopeExisting StructuresFillUtilitiesUSTOther
Provide brief description with distance from proposed structure
Known past uses of site:
Requested # & Depth of Borings:
Lone Star required # & depth of borings:
To be filled by LSH
Price:
To be Filled by LSH
Authorized for quotation only ORAuthorized to proceed
Authorized By:
For:
Date:

MonthDayYear
Date
Should be Empty:

GEOTECHNICAL INVESTIGATION INFORMATION FORM

LSH CLIENT:

PROJECT INFORMATION:

Jobsite Information: