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<br />COUNTY
<br />
<br />I FEDERAL GENCY MANAGEMENT AGENCY
<br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE
<br />
<br />PART 1- APPLICANT INFORMATION
<br />NAME OF LOCAL CONTACT
<br />
<br />DATE
<br />~-J.J-
<br />
<br />~...... .,.. .v.()
<br />PART II-SITE INFORMATION
<br />KEY FOR DAMAGE CATEGORY (11M tlPproprIGt. Ie".,. In 'M UcatQOl')l" bloeb ..ro...)
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<br />
<br />
<br />PHONE NO.
<br />':>'5"-J~J
<br />
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<br />
<br />" ,".,DEBRIS REMOVAL d. WATER CONTROL I'ACILITIES
<br />j~fPRo~e,*IVE MeASURES o.;PU8LIC 8UI"'OI~
<br />.." .Y.'
<br />", '0;. ROAOS'ANO 8RIOGES f, PUBLIC UTILITieS
<br />L~',~<' . SIT~ CArE. LOCATION (U.. molooltlon. tuUNIIo etc.)
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<br />,', DESCRIPTION OF DAMAGE , #,4",,"f R~jJJ() 1I.v41-~~ C..o4'SPd Spp~..4b,c- C!.-Jt,'/a
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<br />.. I'ACILITIES UNDER CONSTRUCTION
<br />II. PRIVATlNOIW'ROI'~'f
<br />L PuBLIC RECR"TION
<br />
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<br />" COMPLETE
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<br />COST ESTIMATE
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<br />LOCATION (U.. map location. addntat, etc.)
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<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
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<br />CATE- LOCATION W....... -... __ .",,/
<br />GORY
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<br />r, IMPACT,
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<br />DEScRIPTION OF DAMAGE
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<br />" COMPLETE COST ESTIMATE
<br />
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<br />
<br />NAME OF INSPECTOR
<br />~e?.IV Sl'-P~"o '-
<br />
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<br />
<br />AGENCY
<br />;: If ..., A
<br />C O&' I'(
<br />
<br />PHONE NO.
<br />OFFICE
<br />~ YL/ . .;..., ~ .p
<br />55'9- ~ J /,
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