FLOOD05478

• County: Statewide
• Basin: Statewide
• Title: Flood Damage Report for 1984
• Date: 5/1/1984
• Prepared For: State of Colorado
• Prepared By: FEMA/CWCB
• Floodplain - Doc Type: Flood Documentation Report

Form Approved
OMS No, 3067-003:3

I,

FEMA DECLARATION NUMBER
FEDERAL EMERGENCY MANAGEMENT AGENCY
NOTICE OF INTEREST DATE
IN APPLYING FOR FEDERAL DISASTER ASSISTANCE , . . ..
PROJECT APPLICATION NUMBER
The purpose of this form is to list the damages to property and facilities so that inspectors may be appropriately assigned for a
formal survey.
REQUIREMENTS FOR FEDERAL DAMAGE SURVEYS
A. DEBRIS CLEARANCE F. PUBLIC UTILITY SYSTEMS
Ii] On Public Roads & Streets including ROW o Water Ii] Storm Drainage
o Other Public Property o Sanitary Sewerage o Light/Power
[;] Private Property (When undenaken by o Other'
local Government forces)
0 Structure Demolition
B. PROTECTIVE MEASURES G. FACILITIES UNDER CONSTRUCTION
o Life and Safety D Health o Public Facilities'
i
o Property o Stream/Drainage Channels o Private Non-Profit Facilities* *
C. ROAD SYSTEMS H. PRIVATE NON-PROFIT FACILITIES..
ir:J Roads o Streets 0 Educational o Medical
o Bridges i"J Culverts ( , . 0 Emergency o Custodial Care
Ii] Traffic Control o Other' o Utility
D. WATER CONTROL FACILITIES I. OTHER (Not in above categories)
I
ItJ Dikes o Levees o Dams o Park Facilities , .\, ,
, ,. ,
.:J Drainage Channels D Irrigation Works o Recreational Facilities
E. PUBLIC BUILDINGS AND EQUIPMENT
o Public Buildings
o Supplies or Inventory
o Vehicles or other equipment
o Transportation Systems
o Higher Education Facilities
* Indicate type of facility.
** Provide name of the facility and of private non-profit owner.
NAME OF POLITICAL SUBDIVISION OR ELIGIBLE APPLICANT m__~==-=mUNTY
TI
BUSINESS ADDRESS 1: COOE
---- -
NAME AND TITLE OF lOCAL CONTACT
31 , iHOME TELEP.H)O~E ~UMBER (lnclud, M'" Cod,)
BUSINESS TELEPHONE NUMBER (Include Area Code)
41 ! .

FEMA Form 90-49, MAY 82

REPLACES EDITION OF MAR BO, WHICH IS OBSOLETE.