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<br /> <br />PRE L1;;'~'~;~ D;.~~C~S~~~~~~'~~NSI;~ ~~~;MA TE <br /> <br />. <br /> <br />PART I - APPLICANT INFORMATION <br />Ni~ME OF APPLICANT NAME OF LOCAL CO NT ACT <br />CO. /)Iv' OF wli4u,e a~,A./ /(It..l(eY <br /> <br />PART II - SITE INFORMATION <br />KEY FDA DAMAGE CA TEGOR Y (Use appropriate letters In the "catej{ory" blocks below) <br /> <br />8. DEBRIS REMOVAL <br />b. PROTECTIVE MEASURES <br />c. ROADS AND BRIDGES <br /> <br />d. WATER CONTROL fACILITIES <br />e. PUBLIC BUILDINGS <br />f. PUBLIC UTILITIES <br /> <br />g. FACILITIES UNDER CONSTRUCTION <br />h. PRIVATE NON-PROFIT <br />I. PUBLIC RECREATION <br /> <br />SITe CATE- LOCATION (Use map location. addreu, etc.) <br />NO. GORY (J/CE4;</C€ C ;?EEI( C//5TIf'E/'fM A;VI:J ,t)0/VA/.fr,1'E>1"'1 of <br />I f3 CO(/A/TY /Jtfl/JC€ t:CCArEtJ f.AJ ~~C ,j>.>-' TlJJ'~ 97tU t1,F 6t'-' ~-"'1. <br />DESCRIPTION OF DAMAGE <br />;<II/E,;f C/fAlvt€C. coA/TlJ./.tJE..S TO S/lIF T (}(/I: To /lEAl//, s/t-Tlk'C <br />of I'1ktft?owS. E,fCH TI.Mc A 5"!flPr OCct.J~> IT E!'fo.t?e.> COt.JA.lTY <br />/(IAO A,<,/O tJEST"ftJYS WILthIP/;; /f/<!EA. hCEAA.le€, C/f/i<IEk. <br />fi/6~iJS TO 8E c!ltf#/oIet/ZEtl ro4A,/Jf51>f,UCE Or .7.5-cJO.FE~r: <br />IMPACT: % COMPLETE <br />l-o-)$ of WILKlt.-IFE 1f1f8/r/fT /r"ulJ tJ€>r/(ucT70.Y <br />OF CO(/A/TY ;rot/t). <br /> <br />/tJ 7" <br /> <br />SITE CATE- LOCATION (Use map tocatio~. oddrea., etc.) <br />NO. GORY >A-Ye:~ PITcH LOcATEtJ 0# ,o/c€,tI,A/CE cl'?€EIC IA) <br />2- /) I? '1 7 W t1F C .H, f'. ,At, <br />DESCRIPTION OF DAMAGE <br /> <br />fletf-OC.4I€ Of:'" <br />nLT€-O VI', <br /> <br />CITe/( I> W'+,1/f/E,/} ovT AAJO PITc/l <br /> <br />r;2-0~~'-) ~/UV~ - <br />nV t.-< / C. / (3 ~ --~<..Eft <br />- <br /> <br />SITe CA TE- LOCA nON (Use map location. addres" etc.) <br />NO. GORY <br /> <br /> <br />IMPACT'L /15) OF 1/?t<(/t>,fniJA/ w-trE.-e rO~ ('</1t.Pt:/~E <br />IN~/TA T. <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />(/ <br />/~ <br />I <br /> <br />L-: u I" V ( c/f'Y"'C-:5 <br />j) ./) ~ GO <br />(--' t;J p;;.. (7t:- ./1 <br /> <br />% COMPLETE <br /> <br />IMPACT: <br /> <br />SITE CATE. LOCATION (Use map location. addre88, etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />" COMPLETE <br /> <br />NAME OF I NSPECTOA <br /> <br />P2A.,r J/1.c ah <br /> <br />AGENCY <br /> <br />C} /)u. J1/a::&r. ~ <br /> <br />PHONE NO. <br />OFFICE HOME <br />f? 7'1-02 72.. <br /> <br />_.FJ'-MA.F".....ao.,I\,l~_.._._._..__._ _ <br /> <br />DATE <br /> <br />PHONE NO. <br /> <br /> <br />1'",0 000 <br />/ <br /> <br />/ <br />,/ <br /> <br />o <br /> <br />COST ESilMATE <br />/ S; tJO V <br /> <br />(Iv <br />2-3 <br /> <br /> <br />ESTIMATE <br /> <br />COST ESTIMATE <br /> <br />GPO 80....,..0 <br />