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<br />FEDERAL EMERGENCY MANAGEMENT AGENCY <br />NOTICE OF INTEREST <br />IN APPLYING FOR FEDERAL DISASTER ASSISTANCE <br /> <br />v V J c.- I (oolt. No. 3067,0033 <br /> <br />FEMA DECLARATION NI*8ER ,;0.-.. <br />~ 7/ -LJe-~ <br /> <br />DAT <br /> <br />The purpose of this form is to list the damages to property and facilities so that inspectors may be appropriately essigned for a <br />forma/survey. . <br /> <br /> <br />REQUIREMENTS FOR FEDERAL DAMAGE SURVEYS <br /> <br />A. DEBR.IS CLEARANCE <br /> <br />o On Public Roads '" Streets Including ROW <br /> <br />o Other Public Property <br /> <br />o Private Property (When undJ!rtllken by <br />Ioazl Goremment forces) <br /> <br />o Structure Demolition <br /> <br />F. PVBUC UI1UfY SYSTEMS <br /> <br />o Water <br />o Sanitary Sewerage <br />o Other. <br /> <br /> <br />. <br /> <br />B. PROTECTIVE MEASURES <br /> <br />G. FAcnmES UNDER CONS1RUC1l0N <br /> <br />o Life and Safety <br /> <br />o Health <br /> <br />o Public Facilities. <br /> <br />o Property <br /> <br />o Stream/Drainage Cwmels <br /> <br />o Private Non-Profit Facilities.. <br /> <br />C. ROAD SYSTEMS <br />o Roads <br />o Bridges <br /> <br />H. PRIVATE NON-PROFIT FACIUI'IES'. <br /> <br />o Streets <br />o Culverts <br /> <br />o Educational <br /> <br />(I 0 'l/ 0 Emergency <br />V X'Uti!ity <br /> <br />L arHER (Not in ttbove ctltegorles) <br /> <br />o Medical <br />o Custodial Care <br /> <br />. <br /> <br />o Traffic Control <br /> <br />o Other. <br /> <br />D. WATERCONTROLFAcnmES <br /> <br />o Dikes <br /> <br />DLcvecs <br /> <br />o Duns <br /> <br />o Park Facilities <br />o Recreational Facilities <br /> <br />, +~ <br /> <br />o Drainage Channels 0 lITigation Works <br /> <br />E. PUBUC BVILDlNGS AND EQUIPMENT <br />o Public Bu1Idinp <br />o Supplics or inventory <br />o Vehicles or other equipment <br />o Transportation Systems <br />o IfIabcr Education Facilities <br /> <br />~ "- <br />'* ~4Z./,tJe, ,,(h!!E]U... 7u/LSON ~e~ <br />M:eI/JP,;~A /1'H!r~ t2.cv#7' <br />A~ t!f2uJd ~,n"k'" a"e L/..ve-s <br />'" /: ~~-/ui'//A~ <br />~ lI!e/'r7T.lk ~ /h/~&#"f~ <br /> <br />· Indicat. type of (vcUity, <br />.. Prouid. ....m. of the fac.1ity and of prilJGt. no,,'pro(it OlD".', <br /> <br /> <br /> <br />HOME TELEPHONE NUMBER (Inc.... A.... CO(NJ <br />