SIGMA RE

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NATIONAL FLOOD INSURANCE PROGRAM

ELEVATION CERTIFICATE

mportant Read the insbuctions on pages 1 - 7.

O. tvi. C. !#.*(*$%!')&,+&$++(+-""

SECTION A- PROPERTY OWNER INFORMATION

BUILDING OWNER'S NAME%$$'"!(&&#

BUILDING STREET ADDRESS (Inducing Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.44525 92ND STREET EAST

STATELANCASTER CA

—Poky

.Compa lAIC Number.. ......

ZIP CODE93535

PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Descrip(ion, etc)TAX PCL NO. 3376-011-001BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.DETACHED

( &&'#$!-5<!$&&"( NAD 1927 NAD 1983SOURCE: GPS (Type):

USGS Quad Map Other:

SECTION B- FLOOD INSURANCE RATE MAP (FIRM)INFORMATION

#"

+(*),

clinging)

B10.0 RS Profile 0 FIRM 0 Community Determined

B11. NGVD 1929 NAVD 1988 0 Other (Desabe):DYes [g] No Designation Data

MING ELEVATION INFORMATION (SURVEY REQUIRED)

Cl Buiding elevations are based on: 0 Construction Drawings* 0 Finished Construction

be required when construction of the bulding is carob*.

C2.

C3.

NGVD1929

Does the elevation reference mark used appear on the FIRM? 0 Yes tg No

2445.CIft(m)

b) _ft.(m)

c)

d)Attached garage (bp of slap 2445. Oft(m)

e)

servicing the buiding (Desate in a Comments area)

f)

g) 2444. ift(m)

h)No. of pemanent openings (

i) ma of at pemanent openings (flood vents) in 3.h

This certification is tube signed and sealed by a laid surveyor, engineer, or architect authorized by law to certify elevation information.C on

US. Code,

crty93534

STATE ZIP CODECA 93535ACASTER

AT: In these spaces, copy the conesponcTmg information from Section ksTREET ADDRESS (Incising Apt, Unit, Suiik anc ig. No.) OR P.O. ROUTE AND BOX NO.

AND STREET EAST

?1/@5;9 ?A>B1D;>%!1935911>%!;>!->/45@1/@!/1>@525/-@5;9!#/;9@59A10$

n Check here if attachments

?1/@5;9!1!&!.A570593!171B-@5;9!592;>8-@5;9!#?A>B1D!9;@!>1=A5>10$!2;>!E;91!-;!-90!E;91!-!#C5@4;A@!.21$

E2.

E3. t(m) _in.(cm) thove the highest adjacent

grade. Complet ite ms C3.h aid

E4. t(m) _in.(cm) 0 above or 0 below (check one) the highest adjacent grade. (Use

Ea ForZone AO only If no food depth nunter is elevatO in azcordance wit the community's loodplan management ordinance?

es DNo 0 Unknown. The local official must certify this information in Section

?1/@5;9!2!&!<>;<1>@D!;C91>! ;C91>"? ;/8;/</%2=+=2?/#-/;=2;-+=276

over oramier's authorized

it Sec s ate knowledge.

crrY93534

11/32006

Check here if Atachments

?1/@5;9!3!&!/;88A95@D!592;>8-@5;9!#;<@5;9-7$

0 The donation in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by &le

management purposes.

0 New Construction 0 Substantia Improvement

_ft.(m)

Check here if attachment

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