HomeMy WebLinkAboutBLD1988-00303 Flood Certificate • JEFFERSON COUNTY
FLOOD AREA CERTIFICATE
Federal Emergency Management Agency
National Flood Insurance Program .
DIRECTIONS
The responsible official shall complete those portions of
Section 1 where necessary information is available in the county
records. In the absence of sufficient data, a registered
professional engineer, architect, or surveyor shall complete this
section. Section 2 shall be completed by the responsible official .
Section 3 shall be completed by the building official .
SECT ION . 1 I
APPL I CANT: I _,__ (gam.
ADDRESS: : C- ,' 0,L J TA" �1'
TELEPHONE: (home) ?i Z--Z Z z. (business)
REPRESENTATIVE (contact) :`
ADDRESS:
TELEPHONE: (home) (business)
PROPERTY D SCRIPTION
ir
GENERAL LOCATION ( ��,+ ,-c 4;. ,,( P047-17
LEGAL:
Identifier Number:
Tax Parcel Number (from property tax statement) :
Real Property Description (from property tax statement) :
S c' —1 Zl( Ai , ie / z tom''
SITE'S DISTANCE FROM MIDWAY: 1' 1S tea 1
BASE FLOOD ELEVATION ( 100 year flood Level ) : A/a..3 i_ cY lFC
SITE'S ELEVAT I CN (grade Level ) : /V107--
A'
SITE ViITHIN FLOODV'JAY: /E- )Eta i c.h4 d ,e4-4 5 of--
PROPOSAL
' PROPOSED USE: ❑ Residential 0 Mobile Home 0 Commercial ❑ Industrial
0 Agricultural ❑ Storage ❑ Other (identify:
FLOODPROOFING MEASURES: YES NO
Landfill 0 0
Pole, pier, or pile 0 0
parallel foundation walls ❑ ❑
Extended walls and basement ❑ 0
Alternative ( identify) : ❑ ❑
i s-`'7C,"` or cG‘_)at eq.-3TA 'To R 3 Lv 4 c-rL L. cr
C k4ei-J v-04A, A/.fC..,.s.c,,___ a 1rA C- NJ k ;,,,c/g y K4 •�-04 N
"Jai- ..f ''fc,-r- re? r A,. ..
• 411
F. I .A. MAP
PANEL AND FLOOD SOURCE: ( ..),f y&L 4 `"- 1 G
ZONE:
ACKNOWLEDGEMENT
I verify the information provided in Section 1 is true and
correct.
(signature) (date)
REGISTERED PROFESSIONAL:
TITLE: LICENSE NUMBER:
SECTION 2 I
CONDITIONS OF APPROVAL
1 . The height of the Lowest floor shall be feet above
grade.
ACKNOL"JLEDGEMENT
The degree of flood protection required by this certificate is
considered reasonable for regulatory purposes. This certificate
approval shall not create liability on the part of Jefferson County
for any -FL damage that results from reliance oh this certificate.
te
z-e/ere
(signature) (d )
RESPONSIBLE OFFICIAL: /94-41-r4---+ V7--e' an (
TITLE: DEPARTMENT:
SECTION 3
AS-BUILT CERTIFICATION
. 1 verify that the structure complies with the conditions of the
flood area certificate.
(signature) (date)
BUILDING OFFICIAL: