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<br />. <br /> <br />FEDERAL EMERGENCY MANAGEMENT AGENCY <br />NOTICE OF INTEREST <br />IN APPLYING FOR FEDERAL DISASTER ASSISTANCE <br /> <br /> <br />-Co <br /> <br />~ <br /> <br />b. L <br />PROJECT APPlIC TION NUMBER <br /> <br />0/7- / t3S5 <br />The purpose 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 />REQUIREMENTS FOR FEDERAL DAMAGE SURVEYS <br /> <br />A. DEBRIS CLEARANCE <br /> <br />F. PUBLIC UTILITY SYSTEMS <br /> <br />co <br /> <br />o On Public Roads & Streets including ROW <br /> <br />~Other Public Property <br /> <br />o Private Property (When undertaken by <br />local Government forces) <br /> <br />o Structure Demolition <br /> <br />.....-0/1 <br />c~ <br /> <br />o Water 0 Storm Drainage <br />,g'Sanitary Sewerage 0 Ught/Power <br />o Other' <br /> <br />B. PROTECTIVE MEASURES <br /> <br />(!CJ <br /> <br />o Life and Safety <br /> <br />o Health <br /> <br />G. FACILITIES UNDER CONSTRUCTION <br />g) Public Facilities' <br /> <br />ii<:I Property <br /> <br />o Stream(Drainage Channels <br /> <br />/"d~ <br />------ <br /> <br />o Private Non.Profit Facilities.. <br /> <br />C. ROAD SYSTEMS <br /> <br />H. PRIVATE 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 Utilily <br /> <br />o Custodial Care <br /> <br />o Other' <br /> <br />D. WATER CONTROL FACILITIES <br /> <br />o Dikes <br /> <br />~ Levees <br /> <br />o Dams <br /> <br />I. OTHER (Not in above categories) <br />o Park Facilities <br /> <br />c <br /> <br />o Drainage Channels <br /> <br />o Irrigation Works <br /> <br />o Recreational Facilities <br /> <br />E. PUBLIC BUILDINGS AND EQUIPMENT <br />o Public Buildings <br /> <br />o Supplies or inventory <br />o Vehicles or other equipment <br />o Transportation Systems <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 /> <br />1 <br />BUSI ESS Aq,gRESS <br />.0. Dok. <br />NAME 0 !LT.-:E OF LOCAL CONTACT \. , . <br />. (JI.wc..r 5,,-,. nl JoWALA./Y{ 1~)~/"7t-T{)R... <br />BUSINESS TELEPHONE NUMBER (lnc/ude Area Code) <br />3 Z3~ ~-S3 <br /> <br /><.if: <br /> <br />C:; <br /> <br />?> / &> ')0 <br /> <br /> <br />4 <br /> <br /> <br />HOME TELEPHONE' NUMBER (IlIclude Area: Code) <br />~/ <br /> <br />FEMA Form 90-49. MA V 82 <br /> <br />REPLACES EDITION OF MAR 80, WHICH IS OBSOLETE. <br />