Laserfiche WebLink
<br />/ <br /> <br />OMB No. 3067-0033 <br /> <br />FEMA DECLARATION NUMBER <br /> <br />fEOERAL EMERGENCY MANAGEMENT AGENCY <br />NOTICE OF INTEREST <br />IN APPLYING FOR FEDERAL DISASTER ASSISTANCE <br /> <br /> <br />DATE <br /> <br />The PU/'P05e of this form is to list the damages to property and facilities so that inspectors mav be appropriately assigned for a <br />formal survey, <br /> <br />A. DEBRIS CLEARANCE <br /> <br />o On Public Roads &. Streets including ROW <br /> <br />D Other Public Property <br /> <br />D Private Property (When undertaken by <br />local Go..mment fon:,es) <br /> <br />D Structure Demolition <br /> <br />F. PUBUC UIlurv SYSTEMS <br />@Water 0 Storm Drainage <br />/ D Sanitary Sewerage 0 Lisht/Power <br />D Other- <br /> <br />i:; <br /> <br />, <br />, <br />l <br /> <br />REQUIREMENTS FOR FEDERAL DAMAGE SURVEYS <br /> <br /> <br /> <br />D Ufe and Safe <br />& operty 0 Stream/Drainage Channels <br />C. ROAD SYSTEMS <br /> <br />D Public Facilities- <br />D PriYllte Non,Profit Faciliti.... <br /> <br />{ <br /> <br />G, F AClUIlES UNDER CONS1RUC11ON <br /> <br />H. PRW ATE NON-PROFIT FACILITIES.. <br /> <br />D Roads <br /> <br />D Streets <br /> <br />D Educational <br /> <br />o Medical <br /> <br />D Bridges <br />D Traffic Control <br /> <br />D Cul..rts <br /> <br />D Emergency <br />DUtility <br /> <br />D Custodial Care <br /> <br />D Other. <br /> <br />D. WATER CONTROL FACILITIES <br /> <br />D Dik.. <br /> <br />OLe.... <br /> <br />o Dams <br /> <br />L fYfHER (Not in abo.. CtftegoriQ) <br />D Park Facilities <br />D Recreational Facilities <br /> <br />D Drainage Channels <br /> <br />D Irrigation Works <br /> <br />E. PUBUC BUILDINGS AND EQUIPMENT <br />o Public Buildings <br />o Supplies or in..ntory <br />D Vehicles or other equipment <br />o Transportation Systems <br />o Higher Education FacIIitiea <br /> <br />-/7~'> /s ,.,. /??,oVJ'"",.,./ /97>"",""",f <br />6-1' l;),k42 ......,/'f-'.,.- c;((..A-,..,.rvy <br />~ n'V'c:!,d'.,u-/-~_~deR. <br />7k ,I'??"7; r _4C.~~,,&f. ~ Z; <br />~ 17 h d 7"t<.-,p k-v,J W~$ ,?,~ <br />/:1'7;",.- -z; nt:, ;,.,c.,tII.,~1 ,p.e....tcd! <br />'"fr1vO -ri~- ~ ,,..,.. c ,,J./$. "c <br /> <br />. Indicate type of {ru:ility, <br />.. Provide name of the facility and of private non-profit owner. <br /> <br />