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<br /> SHEET 2 OF 3 SHEETS
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<br /> FEDERAL EMERGENCY MANAGEMENT AGENCY DATE
<br /> PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE & , 27. !f)j
<br /> PART I - APPLICANT INFORMATION
<br />COUNTY I NAME OF APPLICANT I NAME OF LOCAL CO NT ACT PHONE NO.
<br />:AN M/MIU SAN MI&u(~ COLI ,,,)T 'I <<At; 130 EHLE/l 728-3Cj31
<br /> PART II - SITE INFORMATION
<br />KEY FOR DAMAGE CATEGORY (Use appropriate letters in the "catellorY" block, below)
<br />a. DEBRIS REMOVAL d. WATER CONTROL FACILITIES g. FACILITIES UNDER CONSTRUCTION
<br />b. PROTECTIVE ME ASUAES e. PUBLIC BUilDINGS h. PRIVATE NON-PROFIT
<br />c. ROADS AND BRIDGES f. PUBLIC UT1L1T1E;:S ;. PUBLIC RECREATION
<br />SITE CATE- LOCATION (Use map location, address, etc.)
<br />NO. GORY
<br /> 8eAR (SAN M/6-~~L BP![)&E" J..CXA"IDN M.&I~) I
<br />/ A C:,U: EX - G-1!lEI 60 M - I~ C.C.:H..~l,.V ",
<br />DESCRIPTION OF DAMAGE
<br /> ;/115;1 VEJVCn' :I /;'''1 t7Fr ".vO,-q ('L-''! TricES nl r/-lE t' //(1 '" 2A/'I',l/S, tlfE -tI2.CEJ 7vPP6/..-t;- P
<br />(}I)c Ii 1"1'10 1-H€, cln tl"- PIIIErr 1 iN 6 ';"Ai('l t...J,..\ "r:;::- };.I"o -r-Nt R....NI<j ".. tOU!'lt y !!VA D
<br />bO M tU.~}(r' ',:esl.l t , E,;J /f-I lI,NPE // ('v'''~,J/V(~ or ... ~c: (01.l1V7Y I2V,AI' 2,A")k'~~
<br /> ^Pl1.u; ~ S;ICfil""Tf' 1.t) O. '1 JOW,i
<br />IMPACT: % COMPLETE COST ESTIMATE
<br /> 4/AS}/-O"'S 7,HE C'()/./I'j," ", Ro,l"w ~ ;1{(L f.~) % ~tJPO -
<br /> ~.N ,/ L 0 fS Or- eS c'
<br />SITE CATE- LOCATION (Use map location, address, etc.;
<br />NO. GORY v
<br /> -
<br />2 A FALL C;2CEI< - ,;.", 0 5.,~ P - SS". J1 (~A}.I MIGI-fEL. t'O-.lN1"'1 BNrD~f ,(o~""''t it)N t....Af')
<br />OEseR IPTION OF DAMAGE
<br /> S'A/1f AS sITe :tr; /j I
<br /> APPu' " 0 ~t r'eli ~l, 1" J. (.' ," .'," \ ,'j \! ~
<br /> .-
<br />IMPACT: % COMPLETE COST ESTIMATE
<br /> f".A5f1 - OUTS :).Ie ('t(lN; Y ROAf)S (!.OS:S 0/ - ~('cs-s;) i;?!, % t; .!II c) -
<br /> C,jV
<br /> ,-
<br />SITE CATE- LOCATION (Use map location, address, etc.)
<br />NO. GORY
<br />DESCRIPTION OF DAMAGE
<br />IMPACT: % COMPLETE COST ESTIMATE
<br />SITE CATE- LOCATION (L:se map location, address, etc.)
<br />NO. GORY
<br />OESCRIPTlON OF DAMAGE
<br />IMPACT: % COMPLETE COST ESTIMATE
<br />NAME OF INSPECTOR IAGENCY PHONE NO.
<br /> If ~ , OFFICE I HOME'
<br /> , , 1'"
<br /> .,' /",., I I ' - /,,~ .' , - ; ., ~
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