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<br />FEDERAL e"ENCY .MANAGEMENT AGENCY .
<br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE
<br />
<br />PART I - APPLICANT INFORMATION
<br />
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<br />
<br />I ~U!'lTY I NAME OF APPLICANT
<br />IK/.f J>.tAN't".J R/d 2/fiA/,6j 0
<br />
<br />I'NAME.oF L.OCAL CONTACT
<br />a?~.;V ////,f.,..
<br />PART 11- SITE INFORMATION J.
<br />KEY FOR DAMAGE CATEGORY (UH GPproPriate letter. in the "catelorY" bloc". below)
<br />
<br />8. DEBRIS REMOVAL
<br />b. PROTECTiVe MEASURES
<br />Co ROADS,AND BRIDGES
<br />
<br />d. WATER CONTROL FACILITI!S
<br />.. PUBLIC BUILDINGS
<br />f. PUBLIC UTILITies
<br />
<br />g. FACILITIES UNDER CONSTRUCTION
<br />h. PRIVATE NON.PAOFIT
<br />I. PUBLIC RECREATION
<br />
<br />SITE CATE. LOCATION-(UNmop location. Gddre... etc.} t"kJ? 7y ~'4d "7 ~,v-" -"/"-/6' I r I. r c::>
<br />NO. G~RY .-,;...",..rr 9.fp
<br />
<br />/ C JL /.<"I,,,,',,,,.,.o~ 5",/<:
<br />DESCRIPTIONOFDAMAGE - " .....,~d S/'~~.sf~KY--.,_S"'~~.p /)!"6~/r ,p""'-Q~.4 L,
<br />eN ~A--k.-v,,~:t" ~..ai,,(e,tIP'-f:, ~'ss o~ ..-,....7'"p~ R..p.r.4;....u,~.? Gv"tllllL ~.-, ,,;/R'1"'..o .
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<br />IMPACT: - J... .A1'vd A......... ~ c:vAr.,p. ,PpqR.p tL
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<br />d1 c.7 P/l.. "COMPLETE
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<br />LOCATION (UN map Jocotfon. tlddrc.,. de.) (), ct " 7 Y (/< I? ..4 cI t? b .", '/ s
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<br />SITE CA TE-
<br />NO. GA'V
<br />~ C-
<br />DESC>lIPTION OF DAMAGE /". .I''r. df f'
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<br />IMPACT:
<br />
<br />" COMP LETE
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<br />......Cli:' "':16
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<br />"D.'..v-_,,\~s H,/e
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<br />SHEET OF SHEETS
<br />DATE
<br />6-Z7..J'
<br />
<br />PHONE NO.
<br />.878'- St?:J"J
<br />
<br />.
<br />
<br />COST ESTIMATE
<br />;l&" "''''''
<br />~'. 80 - t:JDc:J
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<br />lCu,",'" .,J<t CVJlIPR~
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<br />COST ESTIMATE
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<br />SITE CATe. LOCATrON(UNmoplocG:tIon.addNN..tC.) et:Jik",'t-'i Rc9..61) q_
<br />NO. G~Y (1"tI~ ,-"""'f'C?OST ~ r--tt;::I ..-..r';/"'F'DS"f- V,)"
<br />"3 C.
<br />
<br />DESCRIPTIONOFDAMAGE U.,."''"( ""J<.,,,,",,s-,,,,,,, .-14'4' s/,'a/er, '#'''''''f /1''''1''''' AevA't-t'''2-
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<br />~A;J.U'~-f Ald'H, A .;J1.......;a" _IL-e s/A',/cA. e;?,c ~.,,,(Jdr rArrPiIf'-P 4/A5 ..d "'-DSS Cl'F A
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<br />R.. 1>", 1d/"9, 9'" /,)",...L f2f't>IA<:.p~.. h 1; ;/A'....S.d-'d.s ""1= V'<>R,!s of:. FILL /'14/eR-iAL
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<br />IMPACT:!"..P..dV'-( !>A--"A<?@, 57R-PTc'?..pS e't'" A ;;I.e? IJ~AI..v
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<br />% COMPLETE
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<br />SITE
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<br />CATE.
<br />GORY
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<br />
<br />LOCA nON (Use map locatlo"_ add,...... etc.) ~~ I? ". yo /C _ .0 d / ? / ~ c?
<br />;t -S..t:'rA~A""e LD"C""" T,*,dI'..., S
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<br /><?OG;~"-y
<br />
<br />DESCRIPTION OF DAMAGE e""unry 13 A! 'd~i'
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<br />IMPACT: ,/iJ,.Ad N4S 1'$..p.p-- c/Qs.,d ~/~c-e
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<br />
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<br />" CO~LETE
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<br />-<-1-4"1
<br />
<br />NAM~OF INSPECTOR
<br />/l:p...... 51' /'1<'.0 <=-
<br />
<br />"AGENCY
<br />FIi"""""
<br />, ~ ,
<br />
<br />PHON E NO.
<br />OFFICE
<br />-;'"14 . 44J.Y
<br />
<br />COST ESTIMATE
<br />.~,4:t
<br />7S,';''''!1
<br />
<br />A./~ e
<br />
<br />" A-r
<br />
<br />l'
<br />
<br />COST ESTIMATE
<br />
<br />30,. t?t::lO
<br />
<br />I HOME
<br />9"94'- 9"?O
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