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<br />... <br />,J . <br />~ . <br /> <br />FEMA DECLARATION NUMBER f) <br />f .:. - 1<"- <br /> <br />OA~U <br /> <br />PROJECT PLICATION NUMBER <br />Os: - ~ 3<:04-0 <br /> <br />The puroose of this form is to list the damages to property and facilities so that inspectors may be appropriately assigned for a <br />formal survey. <br /> <br />FEDERAL EMEAGENCY MANAGEMENT AGENCY <br /> <br /> <br />OMS No. 3067.0033 <br /> <br />NOTICE OF INTEREST <br />IN APPLYING FOR FEDERAL DISASTER ASSISTANCE <br /> <br />REQUIREMENTS FOR FEDERAL DAMAGE SURVEYS <br /> <br />A. DEBRIS CLEARANCE <br /> <br />F. PUBLIC UTILITY SYSTEMS <br /> <br />o On Public Roads & Streets including ROW <br /> <br />o Other Public Property <br /> <br />o Private Property (When undertaken by <br />, local Government forces) <br /> <br />o Structure Demolition <br /> <br />o Water <br /> <br />o Storm Drainage <br /> <br />o Sanitary Sewerage <br />o Other' <br /> <br />OUght/Power <br /> <br />B. PROTECTIVE MEASURES <br />I8l Life and Safety <br /> <br />G. FACILITIES UNDER CONSTRUCTION <br /> <br />..... <br /> <br />IX! Health <br /> <br />o Public Facilities' <br /> <br />QtJ <br /> <br />~ Property <br /> <br />o;!I Stream/Drainage Channels <br /> <br />o Private Non-Profit Facilities" <br /> <br />C. ROAD SYSTEMS <br /> <br />H. PRIV ATE NON-PROFIT F ACILmES.. <br /> <br />o Roads <br /> <br />o Streets <br /> <br />o Educational <br /> <br />o Medical <br /> <br />o Bridges <br />o Traffic Control <br /> <br />o Culverts <br /> <br />o Emergency <br />o Utility <br /> <br />o Custodial Care <br /> <br />o Other. <br /> <br />D. WATER CONTROL FACILITIES <br /> <br />I. OTHER (Not in above categories) <br /> <br />~ Dikes <br /> <br />o Levees <br /> <br />o Dams <br /> <br />o Park Facilities <br /> <br />Co <br /> <br />181 Drainage Channels C!!l Irrigation Works <br /> <br />o Recreational Facilities <br /> <br />E. PUBLIC BUILDINGS AND EQUIPMENT <br /> <br />o Public Buildings <br /> <br />co <br /> <br />o Supplies or inventory <br />~ Vehicles or other equipment <br />D Transportation Systems <br /> <br />o Higher Education FacilitiOli <br /> <br />.. Indicate type of facility. <br />-* Provide name of the facility and of private non-profit owner. <br /> <br /> <br />NAME OF POLITICAL SUBDIVISION OR ELIGIBLE APPLICANT <br />C.ITY of GUN 15D1II <br />BUSINESS ADDRESS <br />II). W. V/~GINI" WoPI51J1lI <br /> <br />NAME AND TITLE OF LOCAL CONTACT <br />E Ot.J /I~ <br />BUSINESS TELEPHONE NUMBER (/nclude Area Code) <br />~3 - "" 1- ~ .t/ 45 <br /> <br />(ZJ <br /> <br /> <br />ZIP CODE <br />8 fJ. Ul <br /> <br />'\ <br /> <br /> <br />clrj' pJIIAJA6E~ <br />HOME TELEPHONE NUMBER (Include Area Code) <br />30.:$ - ~ # / -,23;% <br /> <br />FEMA Form 9Q..49. MAY 82 <br /> <br />REPLACES EDITION OF MAR 80, WHICH IS OBSOLETE. <br />