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Flood Control Preliminary Elevation Certificate FM-1 AO/1M AO <br /> 1. APN 021-120-30 Date 07/08/2014 Chock Form Used mn <br /> ta <br /> Flood Zone X(Historical) FMA AO JE FM-1 AO M <br /> n ,.� Working The YOU <br /> Base Flood Elevation r Depth(c'cle one) r-C✓'' Above Highest Original Immediate Adjacent Grade <br /> (AHOIAG)' <br /> Minimum M/H Substructure Elevation N/A Above Highest Original Immediate Adjacent Grade <br /> Minimum Equipment Elevation 2.0 ft. ffA6G1 Above Highest Original Immediate Adjacent Grade <br /> Minimum Finished Floor Elevation 2.0 Q. kjAC7 Above Highest Original Immediate Adjacent Grads- <br /> ASCE SSudure Classification <br /> Signature ASCE Minimum Floor Elevation`(DPE) '(Design Frood Elevation) <br /> The information below must be signed and sealed by a licensed land surveyor or qualified civil engineer <br /> authorized by law to certify elevation information. I certify that the information on this sheet represents <br /> my best effort to interpret the data available. (See instruction sheets for details on completing this form). <br /> Main Structure/Residence/Addition <br /> 2a. Datum AHOIAG - 2b. Datum AHOIAG <br /> Original Highest Adjacent El. Original Highest Adjacent EI. <br /> Depth of Fill Material! uct 4z' o (Circle 0170) Depth of Fill Material/Structure (Circle one) <br /> Min.Finished Floor EI. /SZ.o Alan, /sy&�e.beX Min. M/H Substructure EI. <br /> Difference /0"o/ a/-�" h9/'er Difference <br /> S 9loot-./vc f.OP <br /> ri✓,%diNy, (Complete this section for Manufactured Structures) <br /> 3. Water Tank/Equipment oPreexisting <br /> Datum Mifq i1/ ifQ None - <br /> Original Highest Immediate Adj. Elev. ///1T,O q(p t i1/ea/coma/' Aa b�p/ace,4 qea Al. <br /> Depth of Fill Material ructur l Z.0 (Circle one) `5f'PC r�G PrVoyEO bArn. {fa/o rw Y-)4'3 <br /> /�rZo. i 5 /'f8.r !F (✓ELL /5 SIYUAT27J <br /> Minimum Equipment Elevation Pic EZ4=-1/A7'Fp <br /> L�A"No✓,e FfAG- tQ�lB,vlENTrcEG T9Nk <br /> Difference �Z.O fr so N�EPS 7D �E FZEI/�rEO. <br /> 4. Propane/Butane/Fuel Tank Datum /4yp OPreexisting <br /> ��e o None <br /> Original Highest Immediate Adj. Elev. arc: p2oPAUE rq �e L-0c <br /> �'rno+t <br /> alkrrcµ <br /> Depth of Fill Material/Structure �Z !/4 6 (Circle one) Ar T4iy fi/g6, 17 Ar Io N OS'ro <br /> '?t ELev.4ra:o,4No Aei,-f4aj-�E'G <br /> Minimum Equipment Elevation Z � iFGL Ur7ZrriE3 /36 E•7&v4-rjYp <br /> Difference f Z l�/jt/C f� F Zr �1 bove y,�h is r dirt= r de C'u <br /> 5. Certl'fiers Name Company Name <br /> Gl�1Lf�12.c�Jlfa/ 5'/�LIP �/,(ayy� G!I7l//7Sy�G//t'✓ZdFr- LAND <br /> Title p� ^M License umber y�J SU9�, <br /> /��ij �y// %Vli/G✓dU/ GS 7��.� <br /> Address 2Z1 Al ejpe 3� Oro P <br /> City 1-016 Stater,4 9 Zip Code 9��yy * .7736 <br /> ,t <br /> L�1- <br /> Tephone Cell <br /> Signature Date �l/ j PL F R6IC, SFO E <br /> a <br /> Owner Signature---�^`��-� %� -u Date " 30 <br /> Printed:4/28/2010 F E M A Elevation Certificate is required prior to final Questions?,Call(209)953-7612 <br /> J:IFLOO"..d Zone ConMd.nVl.o Zane PAMPHLE'nFORMS&HANDomSIEacsftFM Forms 04-28-10 <br /> Reset Form ' Print Form.:. <br />