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<br />,'li\"If-JA.:'., <br /> <br />/~(;E AS$lSS~,U.:.N I :'..[.)I,'j ""1.B Y <br /> <br />. <br /> <br />I &'/~r/~~ <br /> <br />PAHT I - APPLICANT INFORMATION <br /> <br />(S:..J:\I1Y <br /> <br />n2~!::E/]r . <br />F(,PULA TION <br />. <br /> <br />1."~"'~F. vF APPLICANT -- , <br />(! ()4;Z2ULAfuy_ __. <br />iQTAL BUOGI::T <br /> <br />NAME OF LOCAL CONTACT <br />L-otLJ.:b;"; L!d <br />MAINTENANCE BUDGET <br /> <br />PHONE NO. <br />.P2~-:;;/C; d <br />DATE FY BEG/;;,is--- <br /> <br />Approyl:td$ <br /> <br />Baf..nce $ <br /> <br />Appro\Oed $ <br /> <br />Balance $ <br /> <br />CA'TE- <br />GORY <br /> <br />NO. OF <br />SITES <br /> <br />PAR r 11- COST ESTIMATE-SUMMARY (COlU/'LETE SITE ESTIMATE BRFORE SUMMARILING BELOW) <br />POTENTIAL LOCAL FUNDS FOR RECOVERY <br /> <br />TYPES OF DAMAGE <br /> <br />COST ESTIMATE <br /> <br />I <br /> <br />FUND/ACCOUNT <br /> <br />_' AVAILABLE BALANCE <br /> <br />Cl <br /> <br />z <br /> <br />TRee /;rJD ZJ,e,rT Rrh'()#L <br />Mc;n l?/~e~ C#7?N-.J€L <br /> <br />/0000 <br />r <br /> <br />c. <br /> <br />is <br /> <br />...0AL;/)~7 ::;Ji7-c~i ,/}/.):::' /l3//-:r <br />/ <br />RC/-"H/~. <br /> <br />ZB Cleo <br />/ <br /> <br />TOTAL <br /> <br />.g", O()C <br />PART III - DISASTER IMPACTS (USE SEPARATE SHEETS IF NECESSARY) <br /> <br /> <br />TOTAL <br /> <br />A. GENERAL IMPACT <br />1. Identify and describe damages which constitute a health and/or safety hazard to the general public. <br /> <br />IJJIK <br /> <br /> <br />2. Population adversely affected directly or indirectly by the loss of public facilities or ~amages. <br /> <br />No <br /> <br />3, What economic activities are adversely affected by the loss of public facilities or damages? <br /> <br />/)J I) C <br /> <br />B. RESPONSE CAPASl LlTY: Can the applicant respond and recover from the damages quickly and without degradation of public services? Describe, <br /> <br />,0-5, /!/{ <br />/'1,)7.) <br /> <br />,4/?/",/J S <br /> <br />Ct E../!;kJl::- 0 <br /> <br />,.45 <br /> <br />kFC'D <br /> <br />.p)/ 5'>'?J7C hRCC S- <br /> <br />/J?';NJ TC/J<:C".c.c:- <br /> <br />hfilVS <br /> <br />C. IMPACT ON PUBLIC SERVICES IF DECLARATION IS NOT MADE: e.g., Deferral of permanent repairs. impact 00 ongoing services and capital <br />improvements. etc. Describe. <br /> <br />;;::77"[ ///".../.17r;,J?.......cc <br /> <br />hHJZ) 2)""P//-'770A.) - i;?c,- Vi. c'c- 0 /-I:~ y 0/Zi//C-C, <br /> <br /> <br />AGENCYC~~,.-",~ .?'9'"t:,,/. "75 <br />n ""'-A ~/"',.-""..0 a-y/::,/C7~ <br /> <br />PHON~O. <br />l!529-Sc:J/O <br />&3~- ~3 <br /> <br />FEMA Form 9G-80. JAN 84 <br />