<br />
<br />COUNTY
<br />
<br />FEDERAL .GENCY MANAGEMENT AGENCY
<br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE
<br />
<br />PART I - Al'PLlCANT INFORMATION
<br />NAME OF LOCAL CONTACT
<br />
<br />DATE
<br />
<br />NAME OF APPLICANT
<br />
<br />PHONE NO.
<br />,J.?3-/:?3s
<br />
<br />'S-S 1 C OF Co'-o~A40' ~€,y B u ~
<br />PART 11- SITE INFORMATION
<br />KEY FOR DAMAGE CATEGORY (U.. GPproprl4t."turw In tI.. "c.t.,ory" b'ock. "'.~IUJ
<br />
<br />e. DEBRIS REMOVAL
<br />b~'''ROTeCTIVI! MEASURES
<br />Co 'ROADs-AND BRIDGES
<br />., .
<br />
<br />d. WATER CONTROL FACILITIES
<br />.. PUEU.IC BUILDINGS
<br />f. PUBLIC UTILITIES
<br />
<br />g. FACILITIES UNDER CONSTRUCTION
<br />h. PRIVATE NON.pROFIT
<br />I. PUBLIC RECREATION
<br />
<br />SITE CATE- LOCATION (U.. mq JoCGtlon. .dd...... de.)
<br />....0. aORY
<br />
<br />I
<br />
<br />.. /Y#RI(J(JJ ?, C J9 r,~'; S
<br />
<br />"...... le--eJT~ SLoP4:
<br />
<br />~.
<br />
<br />OESCRIPTION OF DAMAGE
<br />[;"~lEIJJlTv~i'.s rll..Oh ~ve"""'~;'l Gl7e4fE"~~ ~~.....T'''7EA"C'1 ~GJA.?
<br />
<br />711...",,,,, 411" ",oEt?k kJOl"l:-lI ~ ~S reI"? - ~ 5":,,"'''' _ t-JP
<br />(l::i:t1AOfLC'ilt.. /tCV_u::;'L Ass:'#"r;t,..~E _1t.:!J~tlO'_ oJ!- _"
<br />/9EA,AL I'N.;-"fJlf(A-PUY <-,F r€.(u.t'J.I"''',I9#"r~/ 11/"'t::-.II$_ ~.s:4dD'-,J !f_
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<br />trek,;&. J~;' '- I .... ~ _.,t,I,; vL "'"An:- H, 'A"a...;I' PC-/'"
<br />IMP~CT:.~~ _ -~:',~:.~> "COMPLETE
<br />
<br />~" ')~1i"~>~7~;: .. ~cf:" '''?
<br />
<br />I'd 0"" OJ'-
<br />COST eSTIMATE
<br />
<br />
<br />LOCA TIOH (UM m." location. adcIreu. ek:.)
<br />
<br />OF DAMAGE
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<br />IMPAc:T',:
<br />
<br />
<br />.y: ~OCATION (u.. _ _lion, add..... etc.)
<br />';t4:~~:~~ .
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />fl . /"o"~.\
<br />706 8"0
<br />
<br />",'<:'.
<br />
<br />DESCRIPTION OF DAMAGE
<br />
<br />".
<br />
<br />L'-'
<br />
<br />c
<br />I'~
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<br />
<br />IMPACT:
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />
<br />SITE CA1'E. LOCATION (UM Mcrp locotIo... add...... dc.)
<br />NO. GORY
<br />
<br />DESCRIPTION OF DAMAGE
<br />
<br />IMPACT:
<br />
<br />" COMPLETE
<br />
<br />COST eSTIMATE
<br />
<br />NAME OF INSPECTOR
<br />
<br />AGENCY
<br />
<br />PHONE NO.
<br />OFFICE
<br />
<br />HOME
<br />
<br />FEMA Form 110-81, JAN 84
<br />
<br />QPO 10".760
<br />
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