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<br />'. FEOERA;t;RGENCY MANAGEMENT AGENCY SHEET OF SHEETS
<br />.
<br /> DATE
<br /> PRELIMINARY MAGE ASSESSMENT SITE ESTIMATE
<br /> PART I - APPLICANT INFORMATION
<br />COUNTY 1 ,NAME OF APPLICANT TNAMEOFlOCALCONTACT PHONE NO.
<br />'[)Ct.TA St.4Tt DIV~IO/ll of WILDLIFe F~ep "'IlL. If'7,y-.JI1+' S
<br /> PART 11- SITE INFORMATION
<br />KEY FOR DAMAGE CATEGORY (U.e appropriate ktte,.. in the "cate,ory" bloc". below)
<br />e. DEBRIS REMOVAL d. WATER CONTROL FACILlTIe:S g. FACILITIES UNDER CONSTRUCTION
<br />b. PROTECTIVE MEASURES e. PUBLIC BUILDINGS h. PRIVATE NON-PROFIT
<br />c. ROADS AND BRIDGES f. PUBLIC UTILITIES I, PUBLIC RECAEATION
<br />SITE CAT~ LOCATION (Uu map location, oddre... etc.)
<br />NO. GOR EScALANTe w/UJ J./F& ~FuMf
<br />I Z2.
<br />DESCAIPTlON OF DAMAGE "
<br /> /lfto~ 7.0 L.'" ~T OIXf! CO""i,;TcLY IVAflllfD AWAY 4Ht>W1}lG .;.NE ~/1I1f~ ro
<br />eDtl6't t-1..t~ "F .,.,. e "I.r.e'A IN {U,PJNCI 41S~/(..1. r"'/l~" Fle-'-P,J'
<br />I MP ACT: t/J fT % COMPLETE COST ESTIMATE
<br />,Hi $1'1j1f: /)IY/IIDII Dr WIJ.D"IF€ ...,O".P j.,(J'.J F' .."iJ' .s?l 15; c)VO -
<br />~F 1l~<):I r,IJ AU-IJ.J NG .,.0 :T NIIJI{),ATIOfl t9
<br />SITE CATE- LOCATION (Use map location_ addre., etc.)
<br />NO. GZ
<br />e 6$(.ALANr& WJJ.f) #./'~ I2F't.l6t:
<br />DESCRIPTION OF DAMAGE
<br /> AP~(Ji ?O ~," (IF C'DN(It7e JIN~ I AlUfrAT 10/'1 l)IH/'t flU1"'Ad/tlelJ H~AIIJ"t;,
<br />7'kll InN G, .04}/ II (~At/l.I1J6 t>...1!' 1'0 ~NPFP. CI4tIN(;,.r tP-F t?ff!. ;. . S", c. APASAtFAJ'T"
<br />iH! 1/21fIf..I>o't ION ~''t~H,
<br />IMPACT: LA '" cAPAtlJJ.ITy 70 jU/G-Ai~ A Gf./(IILTlltAI. % COMPLETE COST ESTIMATE
<br />Ptu. (/lAY 1:Je'/)J &/ /A'IHJ--
<br />SITE IZ LOCATION (Use map location, odd",.., etc.)
<br />NO. GOl'!
<br />3 E'SC.IIl.MI7" WILD LI Fe 1(~"V6u
<br />OESC IPTION OF DAMAGE s' ~EFP A'A4> ,#'1201'1 1.0 ' to I.f'
<br /> 7/;10 812 DO PIN (, f'eI#i2.r ( I A,~Jt r /2 ACf'I2I) API() '/(
<br />(JT: PcBl.IS (..sll.t) P~'O.l ,"eo IN 7~&"" D..$ '1'0 r~Nf)Ar!(J11 "r TtiE. Rt5"F 1./'-' 0
<br />AReA. ';>(LcPGJfI(;. I2E4lu JIlEP
<br /> -
<br />IMPACT' IF PIlCP(i.I Nt:r u/c1u: NtlT J)rN~ tH~ I3I(t1QfJ/N6- % COMPLETE COST ESTIMATE
<br /> , ~ 71., ;Z sO
<br />f'Pf'JDt Wo ....... Sll~' J.lAilf A Dd""r~ OF AfOM,/( 1 Yt Tl) II ner. 6J -
<br />'T ~~F AHJ 1M PAI'T,
<br />SITE [Z LOCATION (UBe map location, address, etc.)
<br />NO. GOR
<br />~ ~c. t~(A...ItI.Jt5 WILl) I./F'e f(€Flu..e
<br />DESCRIPTION OF DAMAGE ~uR. ]0 ">( .!()' t:lI L 1/61.; r.s ?~\.j"E D . ,lJ>}1111 ..P68/VJeJ. 'AAII) tWO
<br />1(p";/. 20' C.UIJ6if.7l!1 wEltS "., AUI"" '110'" ,,/olD Altfi f"!1.Ll'f'l6
<br />IMPACT' l)AAH~ ....',HJ}J tH~ RE'Fi4 ('E A/t.~A &.oJ"IHl> % COMPLETE COST ESTIMATE
<br /> Bf! ~n't~C'T~D. t) .Z,O/JIJ -
<br />NAME OF INSPECTOR AGENCY PHONE NO.
<br /> OFFICE I ~~~~r~.
<br /> ,.,., J '-' , c...'- ...........,
<br />
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