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<br />
<br />FEDERAL E GENCY MANAGEMENT AGENCY
<br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE
<br />
<br />PART I - APPLICANT INFORMATION
<br />NAME OF LOCAL CONTACT
<br />1< UJ c t> e>..v . b j) .. I S
<br />ART 11- SITE INFORMATION
<br />KEY FOR DAMAGE CATEGORY (UN approprltJt.leHer. In tIN "cat.",,,," bloc"s II_low)
<br />
<br />DATE
<br />6-::>3-F:~
<br />
<br />PHON E NO.
<br />9;U~].<]~
<br />
<br />8. DEBRIS REMOVAL
<br />b,. PROTECTIVE ME_ASUFlES_
<br />Co ROADS ANO BRIDGES
<br />
<br />d. WATEflI CONTROL. FACILITIES.
<br />. "
<br />, . , , - .
<br />.. PUQLI<;ilUI/.OINGB
<br />f, PUBldcUTILlTIEB
<br />
<br />Do FACILITIES UNDER CONSTRUCTION
<br />h. PRIVATE NOf:4-PROFIT . ",
<br />I. PUBLIC ReCREATION'~
<br />
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<br />SITE CATE- LOCATION (Use mop location, odd...... efe.)
<br />NO. GORY .r< _;I"~ ~.I' PIP,:Vc',' 'c ~'p~1( <1",7 '" ~
<br />S
<br />
<br />CAR El....J!:>A l. e
<br />
<br />DESCRIPTION OF DAMAGE -;/
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<br />
<br />r.. R"'I'I<>Cf> (Ov/vp,p;r ,N..",D t:</"'~>. 3(, // C."-h..-.-,,,,;'-
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<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />1. r"i'{/.);rI../r &'1'$/'" S;re
<br />LOCATION (UM mop location. Clddre... etc.)
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<br />. IMPA~T: ~"A ~ A 13.....p ,/.S ,/~i"-tl',$ A.i,J. t!, se> T.~.plf.p ...,04 ~ "COMPLETE
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<br />LO.CAJION:, (""'~ locatfO:~:"d~, et(f:.) ,~~t.~~,_;c.' .-"" ';';_' :', .
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<br />IMPACT: a"",nT'( jJlP<'I".fP" ./pw ....." "'''-e
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<br />CIf'e:'S'/...v9S
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<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />CJ
<br />
<br />013,) 17~
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<br />t,',''''''
<br />t.i ~-
<br />
<br />SITE CATE. L.OCATION (U.. ".cploeGtlon. add...... _fe.)
<br />NO. G~RY re'f/"9 PA~ Re>A'r> i ..,sT
<br />(l c ' "
<br />DESCRIPTION OF DAMAGE MW/) $LI/J.p
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<br />
<br />IMPACT:(!"'t/"7r. 1'~"?"f"5 cv "'9
<br />feR f?O.&>d 1.....~f,.4" ,p~ ~'LLJJ~9' ChLJ~A-r ,IV
<br />. I .., ''''' f
<br />,d" t- v, II ~,"'f'
<br />NAME OF INSPECTOR
<br />R,.v Sf>""'Ot.
<br />
<br />L _...... 1110.,. - /~
<br />
<br />FEMA Fonn 110-81. JAN 84
<br />
<br />
<br />"COMPLETE COST ESTIMATE
<br />M,NJAU"'~ A. Jt) J] e7e::>
<br />
<br />C. () IS'" ,""""
<br />PHONE NO.
<br />OFFICE
<br />~.J" - "'''' ~ t'
<br />I
<br />
<br />
<br />AGENCY
<br />~H__'"
<br />(" i>~ II
<br />
<br />."0 .U-7IO
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