|
<br /> FEDERAL .GENCY MANAGEMENT AGENCY SHEET - OF SHEETS
<br /> ,
<br />/2 DATE
<br /> PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE 0-"2 ';:>- a='Lt
<br />/. PART I APPLICANT INFORMATION
<br />~UNTY J NAM~ OF APPLICANT ,NAME OF LOCAL CONTACT PHONE NO.
<br />/,',"io ~t.o.vC<? ~'O ~L.u-vC6 Rd..v JlI</('t''/ !7J' -S&>~~
<br />( , PART II SITE INFORMATION ,
<br />,- KEY FOR DAMAGE CATEGORY (Use approprlat. lelt.",'n the "cate6or)'" bloclr. below)
<br />8. DEBRIS REMOVAL d. WATER CONTROL FACI LlTII!S g. FACILITIES UNDER CONSTRUCTION
<br />b. PROTECTIVE MEASURES e. PUBLIC BUILDINGS h. PRIVATE NON:PROFtT
<br />c. ROADS AND BRIDGES f. PUBLIC UTILITIES I. PUBLIC RECREATION
<br />SITE CATE. LOCATION (U.e map location. oddreN. etc.) <!4?A i.. c,pPPK ""..vI) C,c,,, "1-., ,eoA!:> e
<br />NO. G~Y
<br />IJ c.....-
<br />DESCRIPTION OF DAMAGE ;I/r.l, t::.V'.<17'-.,,~ If'... .....- t7 C/ ., .;p /P",,"" /) (! '" W S" 1"'1' p....-8"';,K_.,..,1-
<br />{!4't..~1i'.f' A.....l> O1'8R' IS.
<br />IMPACT: " COMPLETE COST ESTIMATE
<br /> A 80 3t>o
<br /> Co 5 7t?cJ
<br />SITE CATE- LOCATION (Use mop location. Gddre... etc.) C'Uh'Ty .f,,,,, /) ,? 8. (? 1ev1?P-"'" ~'L'I"~S.,..S. to ... II .
<br />NO. GORY I
<br />1'1 A-
<br /> -
<br />DESCRIPTION OF DAMAGE R e>e I<. A..... I"::. J).. ~ ~ '5 ~Ro..... .....v ff.o.....X ......" J e>.J ~oA<hv'" '(_
<br />C-I,p-,,-v~p Te> hot' d o..v'P e? e/<' Ii! A $00 r S "f/i"" -rc k.
<br />IMPACT: % COMPLETE COST ESTIMATE
<br /> ~e:> 3c::7e7&::>.
<br />SITE CATE- LOCATION (Use map location. oddn... etc.) e""", .,1- '1 ~.. A l> 1'7 -Q""P'7H F<7te JI; e>tc Cc> h ,ie.
<br />NO. GORY ~.V,,~.
<br />I~ L!-
<br />DESCRIPTION OF DAMAGE C!..OAo1p/"'re <.,v.tJ5h",,,,,r d'F S",qr~ $/dp "BIi','dy-<' A 6", /'I"" onT-,
<br />'</I rh /.,_~ r<!'<I DA-""9<i> 1-0 "'c~T^- ~,ci e A h "'7'r.........,_ }>.." tf>_ A,.oJ p...,""t-
<br />~ 02 .1"<" ~ /.l 1"" ,e> -' Ie> /.,uc.I<<cI e ~caci.er/ /' I. ""X :"1' tJ ,u <<.? Jt, r (h7...dtt..S;- ST~eL
<br />PJ.Anl<';"r C..v Abe<l'T_.pn'i I? 'fl R.I\p 1 r,J..L ~/t-1.. P,t" ~<:J.-./) <r~A (/f' L ~
<br />IMPACT: % COMPLETE COST ESTIMATE
<br /> ~t:?.4b 1$ C/e'S.,c> b & /::!..J S c::70,
<br />SITE CATE. LOCATION (Uu map location. Gddreu, etc.) a e1<< n "r"" iReA /;:> l1' ~,p, ~ "1.:l. S"
<br />Il GORY
<br />4-
<br /> - 1> &> <<..I ..v
<br />DESCRIPTION OF DAMAGE "'" '" l> .4--.1 b 4/AT.p~ {2 t.<<>c.v p-...J~AnK"A>1.p~T I ""/{.v d "..tft[
<br />Idd ,ce,pr of' (i!O.oclCuA'f &<./~ Ie /, .14 .> s/-'c-p IS..... "-' c (.p,d Ii'.pcf. 5'.0...... -e
<br />f)f'f3~/s -4 ..v b ,..-,"'/) 5 r/~,( ~.dS" /0 is.p c /..p..o It' ... d olfC
<br />IMPACT: % COMPLETE COST ESTIMATE
<br /> ,5'ct /;;Lt?d.
<br />NAME OF INSPECTOR IAGENCY PHONE NO.
<br />/i6''''/ >1' p~", t:. Ff{<.vA OFFICE I HOME
<br /> .)..It;.~<'-~JR .,?R -9~'?~
<br />I. ". ~
<br />
<br />/
<br />
<br />(
<br />
<br />G
<br />
|