|
<br />,,/
<br />FEDERAL EMERGENCY MANAGEMENT AGENCY~--'
<br />DAMAGE SURVEY REPORT
<br />DISASTER RESPONSE AND RECOVERY
<br />,_._~~_instrucrions on roversfO)
<br />
<br />1. TO" "EGrON__~ FEDERAL EME~~:~~~~AGEN~---
<br />
<br />2. APPLICANT (State AgencJI, County, City. ete,) ; PA"N0.- ~ -----
<br />
<br />7. 'WORK c~::!lf:lo A~,<;.;;;;,!~t~-~- : J2-'iL--oDaDD-
<br />o EMERGENCY 0 A 0 B I OSR NO.
<br />eD ~J PERMANENT C)<C D DOE D FOG 0 H D I :
<br />
<br />B. OAMA~; rt~':';:~oc~~~;rC?;;;d;;;::tj )
<br />
<br />0,\.13 No. 3067-0027
<br />
<br />-13. ~~~~AR77r/. N~;Z . c~.--
<br />
<br />4, iNSPEC1'lON DATE
<br />l.
<br />5. WORK ACCOMPLISHED BY
<br />
<br />o CONTRACT
<br />WORCE ACCOUNT
<br />
<br />
<br />24931
<br />
<br />6. PERCENTAGE OF WORK
<br />COMPLETED TO DATE
<br />[3]
<br />
<br />Q~
<br />BA. FACILITY iN OR AFFECTS
<br />FLOOD PLAIN OR WET LANDS
<br />
<br />~YES
<br />
<br />o Nil
<br />
<br />QUANTITY
<br />(aJ
<br />
<br />9. OESCRI ?TION OF DAMAGE
<br />HAS.s;v(7 /J;V{) 'fVNU"'t'~rJ6/e 4~j5j,j~5. ) ;<OIl)~AJ':' l.:;,1 J6/"d~T
<br />e Ie. ('oI"J.J('{uJt!e (' oj 1< <.l v," !',Y 5,-,{2~Qo~J:c, v.../'"I/p" 11.(' rov^,{Y h/l-S
<br />1"11J.",/"'~()r'r(> 1<.~.5~",s,6,ily, ~",p Of'! c,..,j"cl ~C)j..s w/"I/('{t. 0', /Vvl ;JulIO
<br />10. SCOP k J
<br />II f{,/J,S,f,,/.f;- sl",)!, l~ l.~ /UJroM"I""tj I., ~vl1!v,ip ~eofc
<br />c..,,,,J/,...,:, A..-O C()~{ p.f{e~"'~s.s of f<t!'I'/j.fJ... l(oll()S bkJ"",., Ihe
<br />1'1 f/n~'t'J /d/tn (2 .::r....Lv-l :-;;;.; ;'01 h" eh .",IJ~ $,"'''<' u;- ,../I/h/lvt" k..", ;'cc~k/"frl('
<br />!t 'ff.:!"-:;<: (t::~~,:r:'!J:.~;I:~ ~;~ra 11/!;r'/"':5~t,,~Jo --''''r A~,o~ 1-0 o+'~1- 12 <>1'I0~
<br />11, ESTIMATED_C()ST~OF'PROPOSEf.) WORK
<br />MATERIAlANDIOR DESCRIPTION .n.,
<br />"7\' Ie)
<br />Uv~.l-o.~<>,,~k'24. Co.J...ve,.c~
<br />-4 :I. ~ .fc... tJ..s.
<br />^'" J. e/:. ;jJe
<br />
<br />T/, ~~!b:~-,,-~~j 4 b"" <"e
<br />
<br />
<br />UNIT
<br />Ib}
<br />
<br />UNIT PRICE
<br />IdJ
<br />
<br />COST (datlars)
<br />teJ
<br />
<br />r
<br />
<br />
<br />o CaN
<br />
<br />~ "4,.,J
<br />
<br />o,ert
<br />
<br />
<br />---t--
<br />--~-
<br />- J ---
<br />------t '
<br />--=-i~-1---- .. . .-
<br />+----. , .--.----
<br />I -----"-----
<br />.~_~l_~_
<br />12. EXISTING INSURANCE (Typ;r--------
<br />
<br />. n.~.__.. +___.
<br />=-t~~---
<br />---~-----_.
<br />
<br />
<br />IIJ TOTAL" S
<br />
<br />I E~IGIBL~.~ 5
<br />~YES~?
<br />
<br />ATTACHMENTS
<br />
<br />,
<br />
|