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U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 <br /> Federal Emergency Management Agency Expiration Date:November 30, 2022 <br /> National Flood Insurance Program <br /> ELEVATION CERTIFICATE <br /> Important: Follow the instructions on pages 1-9. <br /> Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner. <br /> SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE <br /> Al. Building Owner's Name Policy Number: <br /> Mark Lekson <br /> A2. Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Company NAIC Number: <br /> Box No. <br /> 6463 Midtown Rd <br /> City State ZIP Code <br /> Siren Wisconsin 54872 <br /> A3, Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) <br /> Lot 19 CSM#5013 V28 P139 <br /> A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory, etc.) Residential <br /> A5. Latitude/Longitude: Lat.45-832273 Long.-92.317533 Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983 <br /> A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. <br /> A7. Building Diagram Number 1A <br /> A8. For a building with a crawlspace or enclosure(s): <br /> a) Square footage of crawlspace or enclosure(s) sq ft <br /> b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade <br /> c) Total net area of flood openings in A8.b sq in <br /> d) Engineered flood openings? ❑Yes ❑ No <br /> A9. For a building with an attached garage: <br /> a) Square footage of attached garage sq ft <br /> b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade <br /> c) Total net area of flood openings in A9.b sq in <br /> d) Engineered flood openings? ❑Yes ❑ No <br /> SECTION B—FLOOD INSURANCE RATE MAP(FIRM) INFORMATION <br /> B1. NFIP Community Name&Community Number 62. County Name B3. State <br /> Burnett County 550032 Burnett Wisconsin <br /> B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) <br /> Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) <br /> Revised Date <br /> 55013C0429C C 08-19-2008 08-19-2008 AE 956.0 <br /> B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9: <br /> ❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source: <br /> B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: <br /> B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ❑x No <br /> Designation Date: ❑ CBRS ❑ OPA <br /> FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 1 of 6 <br />