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<br />LJ <br /> <br /> C0t~ Form Approved <br />- OMB No. 3067-0033 <br /> FEMA DECLARATI~N ,~UMBER <br /> FEDERAL EMERGENCY MANAGEMENT AGENCY i.... .. / /"., i. <br /> NOTICE OF INTEREST DATE .. <br /> IN APPL YING FOR FEDERAL DISASTER ASSISTANCE / '"./ f o. f <br /> PROJECT APPLICATION NUMBER <br /> .< 1/.. Ii <br /> . / <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 /> REQUIREMENTS FOR FEDERAL DAMAGE SURVEYS <br />A. DEBRIS CLEARANCE F. PUBLIC UTILITY SYSTEMS <br /> o On Public Roads & Streets including ROW o Water o Storm Drainage <br /> o Other Public Property /. o Light/Power <br /> IE" Samtary Sewerage <br /> o Private Property (When undertaken by o Other' <br /> local Government forces) <br /> o Structure Demolition <br />B. PROTECTIVE MEASURES G. FACILITIES UNDER CONSTRUCTION <br /> o Life and Safety lTI1Iealth o Public Facilities' <br /> [jJ'Property ~ream/Drainage Channels o Private Non-Profit Facilities" <br />C. ROAD SYSTEMS H. PRIVATE NON-PROFIT FACILITIES.. <br /> 0 Roads o Streets o Educational o Medical <br /> 0 Bridges o Culverts o Emergency o Custodial Care <br /> o Traffic Control o Other. o Utility <br />D. WATER CONTROL FACILITIES I. OTHER (Not in above categories) <br /> / <br /> / <br /> i!r Dikes o Levees o Dams o Park Facilities <br /> o Drainage Channels 0 Irrigation Works o Recreational Facilities <br />E. PUBLIC BUILDINGS AND EQUIPMENT <br /> o Public Buildings <br /> o Supplies or inventory <br /> o Vehicles or other equipment <br /> o Transportation Systems <br /> 0 Higher Education Facilities <br />. lndicate type of facility. <br />.. Provide name of the facility and of private non-profit owner. <br />NAME OF POLITICAL. SUBDIVISION OR ELIGIBLE APPLICANT ~UNTV <br />r,1 C, jf1J';, ~c"'~ 'ilt iar> District ~.Io. 1 ~ ~ps ,: <br />BUSINESS ADDRESS I ZIP CODE <br /> 137 3rJ Street (P.O. Box 100), Cl i fton, Colorado 21520 81520 <br />NAME AND TITLE OF LOCAL CONTACT <br />m .' (~ \, . i; ~ , :. i i (: ~~ J i)rofessional r:n~ineer: 1-1. H. Li7cr < ,:\ssociates <br />" <br />BUSINESS TELEPHONE NUMBER (Include Area Code) I H(~(~?T~LE~.H:;~.~~~ ~~~BEA (Include Area Code) <br />4]' ,., ". <br /> \ "' . ," l -, I ~ ~ ! <br /> <br />\ <br />, <br />, <br /> <br />FEMA Form 90-49, MAY 82 <br /> <br />REPLACES EDITION OF MAR BO, WHICH IS OBSOLETE, <br />