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<br />PHI- ~.It, l,,'/~H'Y .v~~~~ !~'~~~'S~f~~;~~;1' ';'u'r:~I~~RY <br /> <br />-.-- <br /> <br />p_k/.?21/8Y <br /> <br />L "'L"'oiTY <br /> <br />PART I - APPLICANT INFORMAllQN <br />.--f('''-' -OF-r~PPL'cr,~T -- NAME OF LOCAL CONTA.CT <br />__ COJ-L)It!~ j)d~ . &~ItJ?=~ . -----~ <br />TOTAL BUDGET MAINTENANCE BUDGf:T <br /> <br />PHO.....'E NO. <br /> <br />FOPU LA nON <br />I <br /> <br />:NJi-:2:J-/'2..- .. <br />DAlE FY t3EGINS <br /> <br />Appro...ed ~ <br /> <br />BlIlance $ <br /> <br />Approved$ <br /> <br />Blllance $ <br /> <br />CA"TE. <br />GORY <br /> <br />NO.OF <br />SITES <br /> <br />PART 11- COST ESTIMATE-SUMMAR V (COMPLETE SITE ESTIMATE BEFORE SCMMARILU,:G BELOW) <br />POTENTIAL LOCAL FUNDS FOR RECOVERY <br /> <br />TYPES OF DAMAGE <br /> <br />COST ESTIMATE <br /> <br />FUND/ACCOUNT <br /> <br />AVAILABLE BALANCE <br /> <br />~ <br /> <br />IY <br /> <br />~'-ooO /}NO S~/OE 41 BYJ} Sdi::.I <br />tJ;J/J1~C€ ON <br />F~CJE.('''J'- /lIO M~lt'wltyS ;JJYJ /~ <br /> <br />B <br /> <br />8 <br /> <br /> <br />TOTAL <br /> <br />PART III - DISASTER IMPACTS (USli; SEPARATE SHEETS IF NECESSARY) <br /> <br />A. GENERAL IMPACT <br />1. Identify and describe damages which constitute a health and/or safetY ha~ard to the general public_ <br /> <br />2. Population adverselv affected directly or indirectlv bV the loss of public f~i1ities or ~am8ges. <br /> <br />3. What economic activities are adversely affected by the loss of publiC facilities or damages? <br /> <br />B. RESPONSE CAPABILITY: Can the applicant respond and recover from the damages QuicklV and without degradation of public services? Describe. <br /> <br />C. IMPACT ON PUBLIC SERVICES IF DECLARATION IS NOT MADE: e.g., Deferral of permanent repairs, impact on ongoing services and capital <br />improvements, etc. Describe. <br /> <br /> <br /> <br /> <br />8 <br /> <br />FEMA Form g0..80. JAN 84 <br />