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<br />,/ <br /> <br /> <br />.",. <br /> <br />GENCV MANAGEMENT AGENCY <br />AGE ASSESSMENT SITE ESTIMATE <br /> <br /> <br />SHEET ,? OF 13sHEETS <br /> <br /> <br />CO~~TY J <br />f"l97rf1 D~e <br /> <br />PART I - APPLICANT INFORMATION <br />NA'tE OF LOCAL Cd;; <br />{-Jo (Ii f <br />- SITE IN FORMATION <br />KEY FOR DAMAGE CATEGORY (U.e appropriate lette~ In the "cGtelory" ~dod. below) <br /> <br />.. DEBRIS REMOVAL <br />b. PROTECTIVE MEASURES <br />c. ROADS ANO BRIDGES <br /> <br />d. WATER CONTROL FACILlTI~S <br />eo PUBLIC BUILDINGS <br />f. PUBLIC UTILITIES <br /> <br />SITE CATE. LOCA,T}ON (UM map l~lon, apare...~.) p. <br />7" GO~ S,l-f. <;;0 t;5,;dge '"-' /""f, . <br /> <br /> <br />;iI~::J::;;r7)4~k4 I <br /> <br />'f5,,'d'l' <br /> <br />97.\ <br /> <br />Eas-l o.f <br /> <br />.rl' <br /> <br />IMPACT: <br /> <br />Inl <br />SITe CATE- LOCA.T)O r 'lJIJrtapJDF~7!-addre... etc.j _ ,/1 J // _ <br />NO. GORY 5.H. ffO t5/'~f!. .~ 0 i~ <br />2-b ' <br />DES:RIPTIONO~AMAH /_ ,L /c <br />!?,/fo/ /' ~ ~ ,Y - <br /> <br />k). <br /> <br />')~ <br /> <br />1" <br /> <br />IMPACT: <br /> <br />Inlrl''''''''''( <br />SITe CATE. LOCATION (U" map location, addreA, etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />SITE CATE- L.OCATION (Uu me, Jocation, ad_",.., ete,) <br />NO. GOfllY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />NAME OF IN <br /> <br />AGENCY <br /> <br />c O~ <br /> <br />PHONE NO. <br /> <br />g. FACILITIES UNDER CONSTRUCTION <br />h. PRIVATE NON-PROFIT <br />I. PUBLIC RECAEATION <br /> <br />oS (7. 0-t0l 'b,. rend. <br /> <br />% COMPLETE <br /> <br />ST ESTIMATE <br /> <br />Z 5"1 000 <br /> <br />" COMP LE TE <br /> <br />C ST ESTIMATE <br /> <br />20,000 <br /> <br />% COM~LETE <br /> <br />COST ESTIMATE <br /> <br />" COMPLETE <br /> <br />COST ESTIMATE <br /> <br />PHONE NO. <br />OFFICE <br /> <br />I HOME <br />