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<br />FEDERAL e.GENCY MANAGEMENT AGENCY
<br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE
<br />PART I - APPLICANT INFORMATION
<br />NAME OF APPLICANT NAME OF LOCAL CONTACT
<br />L \5 LA IVC 0 RoA.! /I/L)(.p
<br />PART II - SITE INFORMATION
<br />EY FOR DAMAGE CATEGORY (C.. appropriate lette",'n the "calegory" bloclt. below)
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<br />
<br />
<br />e. DEBRIS REMOVAL
<br />b. PROTECTIVE MEASURES
<br />
<br />d. WATER CONTROL. FACILITI!:S
<br />e. PUBLIC BUILDINGS
<br />
<br />g. FACILITIES UNDER CONSTRUCTION
<br />h. PRIVATE NON.PROFIT
<br />I. PUBLIC RECREATION
<br />
<br />c. ROADS AND BRIDGES f. PUBLIC UTILITIES
<br />SITE CATE- LOCATION (U.. map location. addre.., etc.) e eJ &-c #'1""" '--'
<br />NO. GA'V l
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<br />~"'A1>
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<br />Z,t?CA t-/t:?...J--.S
<br />
<br />DESCRIPTION OF DAMAGE
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<br />IMPACT:
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<br />SITE CATE- LOCATION (UM map 'octltfon, add,..... etc.) C e? 4''' '1" '7
<br />NO. GORY
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<br />Reuob
<br />
<br />SHEET
<br />DATE
<br />
<br />OF SHEETS
<br />
<br />;) 7-J'
<br />
<br />PHONE NO.
<br />fl7J'-~O;L3
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<br />COST ESTIMATE
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<br />DESCRIPT ON OF DAMAGE A S""A~L
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<br />SITE CATE- LOCATION (UM map IOCGtWn, oddren. etc.) C! dI~#?"""~
<br />NO. G~Y
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<br />DESCRIPTION OF DAMAGE";V' If (7(;7 FoC''''''
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<br />COST ESTIMATE
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<br />" COMPLE~S--
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<br />SITE CATE- LOCATION (Use mop locGtlon. oddru" etc.) rt.{ C 1- rt:?.J
<br />NO. GO,.{'Y "
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<br />DESCRIPTION OF DAMAGE b41 13: R is
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<br />Rp...wpUAL
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<br />COST ESTIMATE
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<br />IMPACT:
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<br />" COMPL'i{f
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<br />PHONE NO.
<br />
<br />OFFICE
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<br />NAM.,I: OF INSPECTOR
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<br />COST ESTI,MATE
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<br />I HOME
<br />0'99 ~ 91!?>o
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