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FLOODPLAIN CERTIFICATION (©welling) <br /> To Be Completed By Wisconsin Registered Surveyor or Engineer �� U.! G?G P� 3 <br /> Owners Name MA!?V Lt, Ce,14, Legal Description Le4 4 D-7oq <br /> -2.14.1`•3f•f Of•Do <br /> Address 2 5 O4 S C LI A 54111 LyyF S+.•rtiomputer Number �'� - 6170,0 <br /> o <br /> z G S6,i423r�( ,S f+... County Land Use Permit Number <br /> '� CkbJ3t w) s,14ot ` RFE For Building Site 956.0 <br /> Dwelling <br /> (D) First Floor Elevation <br /> (B) Ground Elevation Distance Beyond / <br /> At Top of Fill Building <br /> (E) Basement or Crawl <br /> (A) Ground Elevation ::...::••':: ' SpaceQevation <br /> At Building Site <br /> (A) Q53.; CAG ` rg.A, , FPryou', <br /> Vertical Datum W Gf "Al 6 L., 8j Jr ss t (H46 <br /> ( ) � g <br /> �/RrrrlYr/� <br /> B <br /> Vertical Control <br /> Monument Referenced p�# 6 Lev. 95333 (C) <br /> (D) <br /> (E) <br /> Comments: t oc m 1 P G N4I l l-R4, tidy W) vy 3 t <br /> l61,A,4 opo 9o' fear, "let 6LEV, qSd /o�v <br /> I hereby certify that the information Name PH 41, hoe"tA <br /> provided on this form represents n <br /> the actual building elevations as Signature— <br /> currently constructed. go$ /QL S <br /> Registration Number l 1 <br /> Dat.=/o 9 <br />