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<br />~
<br />
<br /> ~ SHEET OF ~ SHEETS
<br /> -- FEDERAC ERGENCY MANAGEMENT AGENCY DATE l~~ Jz I
<br /> PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE <- ,-' 4-
<br />-' " '
<br /> PART I - APPLICANT INFORMATION
<br />COUNTY I ~A~~ OF: APP~I~ANT I NAME OF LOCAL CONT ACT PHONE NO.
<br /> '/' , '1 I , '. ,
<br />-~j'" I t':j' ,~ C . l," j,. r
<br /> PART II - SITE INFORMATION
<br />KEYFOR DAMAGE CATEGORY (U<<e appropriate letten in the "category" blocks below) :,! - " , . i -- --
<br /> .1l , " , - , " " i , ,~ t' .... , , , ,
<br /> " 2/ , ~ e~r
<br />.. DEBRIS REMOVAL d. WATER CONTROL FACILITIES g. FACILITIES UNDER CONSTRUCTION
<br />b. PROTECTIVE MEASURES 8. PUBLIC BUILDINGS h. PRIVATE NON-PROFIT
<br />,. ROADS AND BRIDGES f. PUBLIC UTILITIES ,. PUBLIC RECREATION
<br />sITe CATE- LOCATIO,N (UlSe "lap locatio"" addrelSlS, etc.) . ,
<br />NO. GORY I .... '. ,"'~' ,I, --J. i-'. ~..f. . ~~' " .~. . .: e - r, "". ., c
<br /> I f( -- " ~, ..-. " , " "
<br /> , C , 0 --
<br /> , I"'" " ; ( , ., , f' -. " " ,
<br /> o~ '0 U!. , .- .
<br /> - "
<br />DESCRIPTION OF DAMAGE .
<br /> ,..- , -- ,1 .J - , .' ."
<br /> . .~ 1 .- '" ,.... ~;. .,' .' '" (, ~ , -. " , ,'. ) , ,. " , 'f.- - , 1'" ,
<br /> ^, I ! 0
<br /> ,. n- ...,. E': .. . ,', ~ n ~ r ',-', -)/ , 0 . ';.'. .' , , >
<br /> c i ' -- ,
<br /> c' ., " .. .' J '___\':Ir ..
<br /> ,
<br />IMPACT: % COMPLE,TE , COST ESTIMATE
<br /> : ..
<br />- , , , r ; .. . , ~ , . " c..... .,"
<br />, " , ,
<br /> .- ..
<br /> , .
<br /> " " i , /' " , '. f ",- , . ::')
<br />SITE CATE- LOCA nON (Use mpp loca'tion, addre8', etc.) ^~
<br />NO. GORY , ,."j I ....-'". ',.7 :- -, .. -, .-.. " ,--,v . f .. . .. , " .. ..~ ..:. ,
<br /> ..
<br />2- .) / ,)
<br /> - " . 7 ( -. ,. "
<br />L.. r~ " 0 , .. " K " " ., , /'. ',' ,
<br />DESCRIPTION OF DAMAGE
<br />12;,...- \~ , ( ! /" t ,(
<br /> . ,,- . ^ ~ " ". , . " 0 -"{' " , ; " .
<br /> I . . ,
<br /> -- _,J, : / , , If'
<br />~"..~l . .. . , ) . - , .. .' -- -
<br /> " ,
<br /> > ~{~ I "
<br /> . ..
<br />IMPACT: -c- % COMPLETE COST ESTIMATE
<br /> >.
<br /> ,
<br /> , . , " 0 --
<br /> " '. . .. , "
<br /> -. \.. . .
<br />SITE CATE- LOCATION (Use map loctltion, address, etc.) ii, .),:
<br />NO. GORY j ~'. -., .,' , >:....f.',~'\~~ "J""~ , ; ,>,,"t
<br /> ~ ,.
<br />DESCRIPTION OF DAMAGE
<br /> \
<br /> /
<br />IMPACT: % COMPLETE COST ESTIMATE
<br /> ,
<br />SITE CATE- LO~A TI?N (Use map locatiJ" address, et,~,) <C f i .
<br />NO. GORY , X48, R,cJ ''S.?, D L ,/.s~ .~: l) ,
<br /> /0. r ,~ ," '\ L n '';;' , ~ t ." - rl''1. " ' ~,. Li::. ,- , : , , -- ,..--.,... . c....,
<br />4- - I l'-'i~r-.j
<br /> it DC"":..>p C r-1"'pi::- QJ. "). "'0<' (o~ M. :.... "S.,-'r.'
<br /> '- C
<br />o.eSCAIPTION OF DAMAGE
<br /> I " r , i , , .lo:- . , -. /. ., /)
<br /> - .. . " J .. ~ , " , , , .' r:,I,.1.
<br /> ,. ,~. " . f' I < 4 ,
<br /> c. , . -1'-1 y~'-. 7
<br /> - . .
<br />IMPACT: . % COMPLETE COST ESTIMATE
<br /> , " .' . ~ i I . .j:
<br /> , .. '/":1 '1
<br /> . - . ;...... ,'~, . :
<br />:::':i- - ,'.'....
<br /> , . , . ., 0 '" "
<br />N.o.rE OF INSP~.CT~A. AGENCY PHONE NO.
<br /> . . I HOME
<br /> . t ,'') '1 . - , }. OFFICE
<br /> , , . I. I
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