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<br /> <br />vr ':H1t:t:.I::' <br /> <br />FEDERAL EMERGENCY MANAGEMeNT AGENCY <br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE <br /> <br />PART I - APPLICANT INFORMATION <br />NAME OF LOCAL CDNT ACT <br />WiLf)t../~ <br /> <br />DATE <br /> <br />N~}1E 9F A~~C"""T <br />-(""""t" J/ IV., <br /> <br />PHONE NO. <br /> <br />PART II - SITE IN FORMATION <br />KEY FOR DAMAGE CATEGORY (U.e appropriate lette,.. In the "cote,ory" blocb below) <br /> <br />e. DEBRIS REMOVAL <br />b. PROTECTIVE MEASURES <br />c. ROADS AND BRIDGES <br /> <br />d. WATER CONTROL FACILITIES <br />.. PUBLIC BUILDINGS <br />f. PUBLIC UTILITIES <br /> <br />g. FACILITIES UNDER CONSTRUCTION <br />h. PRIVATE NON.PROFIT <br />I. PUBLIC RECREATION <br /> <br /> <br />SITE CATE- LOCATION (U.e map location, Gdd~ etc.) / """'.A ~.... - 10 <br />NO. GORY Ad' ,,00e'1 -:1"0 ~v/c.-~~l <br />/ D." /Z.M'i WI c.,t;;,." Ct:)/~'l".!.. <br />DESCRIPTION OF DA~AGE Le ~e. ,,1. vI' $ ~rn.... ~.,. 0 ~ 4.ee <br />J 1/4.;7 ~ 'rl, t'fow ~ 0 I' C'o;;,~. ~/l/e...... Sc/ bfil1 /,Uf8Ir.l- /"H<l1I <br />r:! A-"'~ #601(./-.)0 ~ 6"""" ~ 'tl I~c/e,"- .$'y::s~_/ 1te$~~A-.,/,.;." <br />d-/ -7~ d~,., ".,....j Il"....f!<!- ~S ,rt:"'PJ,.{ ~ It..r~~ ./t::'I!;> <br />"'/c...... #~4. <br />I~ I~ "'-$'1'11 -.e" - <br />A...cI J,t"'re,[~ 19~e4- t""oY1- SpIIl/w ''; <br />1M itA S Selie -rNIJ I'~., t! ~o .. <br />LOCA ION (U" map location, addre., etc.) ~~".... <br /> <br />It/~ <br />Se~ <br /> <br /> <br />. <br /> <br />% COMPLETE: <br /> <br /> <br />o <br /> <br />12;;ir5oo <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />% COMPLET~ <br /> <br />COST ESTIMATE <br /> <br />SITE CATE- LOCATION (U.e mDP locGtion, addre.., etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />% COMPLETE <br /> <br />COST ESTI ATE <br /> <br />~ <br /> <br />SITE CA TE. LOCATION (U.e maP location, addre.., etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />% COMPLETE <br /> <br />COST ESTIMATE <br /> <br />NA""E OF INSPECTOR <br />,4/.,.,., /Jl"R:r~~ <br /> <br />75'.</ 0 f-/, .3 qm e. <br />FEMA Fonn 90-81. JAN 84 <br /> <br />AGENCY <br />DW/? 16>&-0 <br />Co <br /> <br /> <br />PHONE NO. <br />OFFICE 9~..J1Jt5iHOME <br /> <br />oJ. <br /> <br />GPO 80....7&0 <br />