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<br />NAME O~PLICANT <br />I......J~~~\ <br />TOTAL BUDGET <br />ApprOved$ <br /> <br />FEDER~lERGENCY MANAGEMENT AGENC~;.,-;<:, <br />PRELlMINA DAMAGE ASSESSMENT SUMMARY <br />PART I - Al'PLICANT INFORMATION <br />NAME OF LOCAL CONTACT <br />~\(. l00N Ql~'j.",t)~ <br /> <br />. <br /> <br /> <br />\~4-. <br /> <br /> <br />;~ <br /> <br />aalance $ <br /> <br />MAINTENANCE BUDGET <br />Approved $ Belanee $ <br /> <br />PHONE NO. <br />~t<6 -D \ 06, <br />DATE FY BEGINS <br /> <br />CATE- NO. OF <br />GORY SITES <br /> <br />PART II - COST ESTIMATE-SUMMARY (COMPLETE 81TE ESTIMATE BEFORE SUMMARIZING BELOW) <br />POTENTIAL LOCAL FUNDS FOR RECOVERY <br /> <br />TYPES OF DAMAGe <br /> <br />COST ESTIMATE <br /> <br />FUND/ACCOUNT <br /> <br />~. AVAILABLE BALANCE <br /> <br />I <br />I <br /> <br />8 d.-. <br /> <br />Pro\-..." \-~'l~ ...............s.~....'3. <br />-\0 ~.,...,.\ \; '0'" \- . <br /> <br />\ ~ ,(,,~O <br /> <br /> <br />OTAL <br />\'0 b~ <br /> <br /> <br />TOTAL. <br /> <br />PART III - DISASTER IMPACTS (USE SEPARATE SHEETS IF NECESSARY) <br /> <br />A. GENERAL IMPACT <br />1. Identify and de.sc~ibe damayes which constitute 8 healt_h and/or safety hazard to the general public. <br />Mm,;.-J r """rc./- <br /> <br />2. Population adverseIv effected dil'8CtlV or indirectly by the loss of public facilities or damages. <br /> <br />;J~ <br /> <br />..,)--;0 <br /> <br />3. What economic activities are adversely affected bV the loss of public facilities or damages? <br /> <br />'\ <br /> <br />/V'0YI<e <br /> <br />B. RESPONSE CAPABILITY: Can the applicant respond and recover from the damages qUK:kly end without degradation of public services? Describe. <br /> <br />???J~ tf-r <br /> <br />-<!-'~.s."'~, <br /> <br />~~ <br /> <br />C. IMPACT ON PUBLIC SERVICES IF DECLARATION IS NOT MADE: e.g.. Deferral of permanent repairs. impact on ongoing $8rvices and capital <br />improvements, etc. Describe. <br /> <br />\/"-'-0 <br /> <br />~\l\l.. ( M..... ) <br /> <br />~b <br /> <br />\.A}-"'-\-"''' <br /> <br />\, ' <br />.,Q., V, ;"\1> V) <br /> <br />1(;:"1Cl. -'5: \Gl <br /> <br />PHONE NO. _ <br />j.{,- 4-40-~3~~ <br /> <br /> <br />AGENCY <br />C.G <br /> <br />~ <br />