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<br />fI /tf..o. lu2~~7: <br /> <br />FEMA OEClARA nON NUMBER <br />FEJ1f1 - '7/1 -iJt< -&J <br />DATE <br />:JULY ..20, j0gL/ <br />PROJECT APPLICATION NUMBER <br />0)-'15-.3 7. 0 <br />The purpose of this form is to list the damages to property and facilities 50 that inspectors may be appropriately aSsigned for a <br />formal survey. <br /> <br />FEDERAL EMERGENCY MANAGEMENT AGENCY <br />NOTICE OF INTEREST <br />IN APPLYING FOR FEDERAL DISASTER ASSISTANCE <br /> <br />REQUIREMENTS FOR FEDERAL DAMAGE SURVEYS <br /> <br /> A. DEBRIS CLEARANCE <br />/} 'fr ~ On Public Roads & Streets including ROW <br />r o Other Public Property <br /> o Private Properly (When undertaken by <br /> local Government forces) <br /> o Structure Demolition <br /> B. PROTECTIVE MEASURES <br /> o Life and Safety o Heal th <br /> o Property o Stream/Drainage Channels <br /> C. ROAD SYSTEMS <br /> o Roads o Streets <br />( It o Bridges r Culverts <br /> o Traffic Control o Other. <br /> <br />F. PUBLIC UTILITY SYSTEMS <br /> <br />o Water <br /> <br />o Storm Drainage <br /> <br />o Sanitary Sewerage <br />o Other. <br /> <br />OUght/Power <br /> <br />G. FACILmES UNDER CONSTRUCTION <br /> <br />o Public Facilities' <br /> <br />o Private Non-Profit Facilities" <br /> <br />H. PRIVATE NON-PROFIT FACILITIES" <br /> <br />o Educational <br /> <br />o Medical <br /> <br />o Emergency <br /> <br />o Custodial Care <br /> <br />o Utility <br /> <br />D. WATER CONTROL F ACILmES <br /> <br />o Dikes <br /> <br />o Levees <br /> <br />o Dams <br /> <br />I. OTHER (Not in above categories) <br />($J. Park Facilities <br /> <br />o Drainage Channels <br /> <br />o Irrigation Works <br /> <br />uF <br />--- <br /> <br />o Recreational Facilities <br /> <br />E. PUBLIC BUILDINGS AND EQUIPMENT <br /> <br />o Public Buildings <br />o Supplies or inventory <br />o Vehicles or other equipment <br />D Transportation Systems <br /> <br />o Higher Education Facilities <br /> <br />,., Indicate type of facility. <br />** Provide name of the facility and of private non-profit owner. <br /> <br />NAME OF POLITICAL SUBDIVISION OR ELIGIBLE APPL ICANT <br />1 (!.IT\' OF (jLEIJWOOb SP"I""&S, (IOLOI2;{1;,O <br /> <br />BUSINESS ADDRESS <br />80G COOPEK!.. '('..vE. <br /> <br />COUNTY <br />2 &Ate.FIf"Ct) <br /> <br />ZIP CODE <br />'{ (cO! <br /> <br /> <br />NAME AND TITLE OF lOCAL CONTACT <br />EVIIV t<~!)i...E~ (! {TV [Nc,IN~Et< <br />BUSINESS TELEPHONE NUMBER (f"dude Area CodeJ <br />4 ,::>(>3 - C"J--J':J--v.::,-7,5- <br /> <br />HOME TELEPHONE NUMBER (Include Area Code) <br />- 9td -,3 /8'1 <br /> <br />FEMA Form 90-49, MA Y 82 <br /> <br />REPLACES EDITION OF MAR 80, WHICH IS OBSOLETE. <br />