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<br />/?," <br />f <br /> <br />\ <br /> <br />FEDERAL.RGENCY MANAGEMENT AGENCY <br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE <br /> <br />\ <br /> <br />PART I - APPLICANT INFORMATION <br /> <br />I NAME OF coCGh"\ '\ I~; ~F ;'~ANCONCC~ \\ ~ \ oU <br /> <br />PART 11- SITE INFORMATION <br />KEY FOR DAMAGE CATEGORY (U.e appropr'IDle lelt.,..ln the "cGle60r)l" bloclt. below) <br /> <br />COUNTY <br />RO\fTT <br /> <br />.. DEBRIS REMOVAL <br />b. PROTECTIVE MEASURES <br />c. ROADS AND BRIDGES <br /> <br />d. WATER CONTROL FACIL.ITIES <br /> <br />SHEET ---.l OF <br /> <br />SHEETS <br /> <br />DATE <br />~~""~~." ~4 <br /> <br />PHONE NO. <br />~'l~ ~ 0 \ 08 <br /> <br />.. PUBLIC BUILDINGS <br />f. PUBLIC UTI LITIES <br /> <br />g. FACILITIES UNDER CONSTRUCTION <br />h. PRIVATE NO~-PROFIT <br />I. PUBLIC RECREATION <br /> <br />SITE CATE- LOCATION (U.e mop location, Gddrea. e~ ..L... \ _ \...... .0 n V <br />NO. GORY F \ 00 c\ ,'", S\ I.... o.J t:S UTe. '1'."-" "-'r\, Sc:.. -..: y.." e. ......... <br /> <br />~. Ii \l ~ '1 AM P A f<.\~~ <br />DESCRIPTION OF DAMAGE, , 'D 1-' / \/ '" '.Qll.. Q. V- i \J 0......... \~.. <br />F\o~<:\\"''K '" ~'^o C'OT~"'''' J- ',\ . \ r....,. <br />R.~'i"".,r , l) ~e.. Q...~r- -\-n 'r':o""~ ~ ~q",.\. I ~"-)J 1 <br />G..-'-"''l4..\ ~\t. ~"""'1( ~"-~ \.'tr My. QQ,~'(\-o",. <br /> <br />&~~'~6 ~ <br /> <br />IMPACT: <br /> <br />fle)'< )\........ <br />c.~~ <br /> <br />% COMPLETE <br /> <br />CI. ~ ~lll <br /> <br />r.....o \..-. \- <br /> <br />SITE CATE- LOCATION (Use map location. tulare... etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />- <br />A\\ O\'n........ <br />\---€-q~'- <br /> <br />~ <'>\"^" ......~ ' C>.A..L <br /> <br />a.. S.!>... s;.~e.d <br /> <br />~o <br /> <br />&\~ ...-r <br /> <br />IMPACT: <br /> <br />% COMPLETE <br /> <br />SITE CATE- LOCATION (Use mop location, Gddre... etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />% COMPLETE <br /> <br />SITE CATE- LOCATION (Use mop location, address, etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />% COMPLETE <br /> <br />b<\ \"\~ (\'1k <br /> <br />NAME OF INSPECTOR <br /> <br />RI-\.-M \[ \;'ll '{.\- <br /> <br />(\, , ' <br />I.G ~lu" ~_AV,~\"",. <br />AGENCY <br /> <br />PHONE NO. ( <br />OFFICE ~ \ " <br />,.( ~. -..........-. ~ <br /> <br />,--.. <br />(' p (-- <br /> <br />~S~~:~ <br /> <br />..~ <br />i <br /> <br />COST ESTIMATE <br /> <br />";'( <br /> <br />1'1<", <br /> <br />'It <br />~ <br />i-'i <br /> <br />COST ESTIMATE <br /> <br />COST ESTIMATE <br /> <br />'i5 n- ~'7:l <br /> <br />I HOME <br />