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<br />; <br />, <br />I <br />! <br /> <br /> FEDERAL EMERGENCY MANAGEMENT AGENCY DATE <br /> PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE <br /> PART I - APPLICANT INFORMATION <br />COUNT:t... I NAME OF APPLICANT W {:' (NAME OF LOCAL CONTACT PHONE NO. <br />.Mc~ rdse D,P <I r tV,;' J.; e J; .... t<vvo. d cJY'L :/--4--7 - '] <f 3 I <br /> PART II - SITE INFORMATION <br />KEY FOR DAMAGE CATEGORY (U.e appropriate letter. In the "cate,ory" bloclra below) <br />a. DEBRIS REMOVAL d. WATER CONTROL FACILITIES g. FACILITIES UNDER CONSTRUCTION <br />b. PROTECTIVE MEASURES e. PUBLIC BUILDINGS h, PRIVATE NON.PROFIT <br />c. ROADS AND BRIDGES f. PUBLIC UTILITIES I. PUB~lC RECREATION <br />SITE I~ LOCATION(u.em""loc.tlon..dd......et~.) Z mile 5ou-<...LJ _~ .1t14>1I-roS""<.. )..1-. e"'- ~ <br />NO. GOR dnc..~J,..f/"e. t2/~ f 'I'~.fa Pc~ <br /> . a Ch,.,..:- <br />DESCE7~;;=A~ UJ1de,~t.(/I?~ ~ e.,<id/~ r/tt. -r!?ljJ~ . <br />s/~~ ~_S.Fr ~~ Gt.- 6<J0 1=-1- ~~Z-- ..u-.or b ~/dJ.r <br />No t/~[,c..lt::vf' l""Srd-i' oJI- fJ""es~ fI/'1....e, <br />/ <br />IMPACPrBve..d-<< clic.~d/~ d{ p~j % COMPLETE COST ESTIMATE <br />'10 t s;ooc. <br />SITE CATE. LOCATION (U.. mG,P location. addna, etc.) <br />NO. IGORY <br />DESCRIPTION OF DAMAGE <br /> . <br />IMPACT: % COMPLETE COST ESTIMATE <br />SITE CATE. LOCATION (U.e map location, add rea, etc.) <br />NO. GORY <br />DESCRIPTION OF DAMAGE <br />IMPACT: % COMPLETE COST ESTIMATE <br /> t"" <br />SITE CATE- LOCATION (U.. map locotlon. tJddreN, etc.) <br />NO. GORY <br />DESCRIPTION OF DAMAGE <br />IMPACT: % COMPLETE COST ESTIMATE <br />r;&,;;;PECk~ i-i-INr AGENCY PHONE NO. <br />WAtt.€. ~.J me"" 1"4!f, OFFICE F-r! I HOME <br /><I<h/, ').~qp' <br /> <br />FEMA Form 90-81. JAN 84 <br /> <br />GPO 804'7150 <br /> <br />r:. <br />~,. <br />f. <br /> <br />\;." <br />i-'.- <br />,., <br />fv <br />I <br /> <br />