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<br />- <br /> <br />- <br /> <br />FEDERAL E~ENCV MANAGEMENT AGENCY <br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE <br /> <br />SHEET....s:: 0 SHEETS <br />DATE <br />6/~ '7/ p~ <br /> <br />COUNTY <br />6=a"t..,-e <br /> <br />PART I - APPLICANT INFORMATION <br />rAMEOFLOCAL~NTACT <br />D~-,,> '1;. fl., c. t. r'f!' r..:> it- <> <br />PART II - SITE INFORMATION <br />KEY FOR DAMAGE CATEGORY (Un approprlat~ Jette,.. In the "cole,ory" bl~l!. below) <br /> <br />INAME OF APPLICANT <br />1,.( Cr>/O. ~L"_ <br />, <br /> <br />PHONE NO. <br /> <br />z.~i' 71.JL <br /> <br />.. DEBRIS REMOVAL <br />b. PROTECTIVE MEASURES <br />c. ROADS AND BRIDGES <br /> <br />d. WATER CONTROL FACILITII!S <br />.. PUBLIC BUILDINGS <br />t. PUBLIC UTILITIES <br /> <br />g. FACILITIES UNDER CONSTRUCTION <br />h. PRIVATE NON.PROFIT <br />I. PUBL.IC RECREATION <br /> <br />SITE CATE. LOCATION (UH map location, addre... etc.) <br />NO. GORY <br /> <br />.3 <br /> <br />c.. <br /> <br />Sll <br /> <br />,:3 9 <br /> <br />])c>u ., Ie; ~ <br /> <br />P~.s5 <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />)?1~5$rv e <br />R 0 CI J,.......4 '1 <br /> <br />/ands/,cf-e, cle~;t,.o'1'~ roqJ......Q'7'- <br />(Jr;to fOt.J9'r,€- fro p -€.-r 'fy,- <br /> <br />lfJov~J. <br /> <br />IMPACT: <br /> <br />" COMPLETE <br /> <br />COST ESTIMATE <br /> <br />?O"'i J e-JCH' .!. <br />lOCA nON (U.. map location. addre... etc,) <br /> <br />qnd <br /> <br />ye........."" {LO'$.p", <br /> <br />/0 <br /> <br />,,~,3S 0/000 <br /> <br />SITE CA TE- <br />NO. GORY <br /> <br />*~ ,j <br />DESCRIPTION OF DAMAGE <br /> <br /> <br />IMPACT: <br /> <br />% COMPLETE <br /> <br />COST ESTIMATE <br /> <br />SITE CATE- LOCATION (U.e map location_ add,..... etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />% COMPLETE <br /> <br />COST ESTIMATE <br /> <br />SITE CATE- LOCATION (Uu mlJp location. addre... etc.) <br />NO. GORY <br /> <br />qESCAIPTlON OF DAMAGE <br /> <br />IMPACT: <br /> <br />% COMPLETE <br /> <br />COST ESTIMATE <br /> <br />NA~~~O~ 1/ <br />/1 _:;-....~ <br /> <br />IAGENCY -'- <br />c-.Dt?' , <br />-.. '. <br /> <br />PHONE NO. <br />OFFICE <br /> <br />,.,...... ,............ <br /> <br />I HOME <br />