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<br /> <br />r <br /> <br />PR'~l"!~~-~;A~~~~ b.~~'~~':~-~;~~~~~~~~;)-;~':~-~-~~~,\ fE' <br /> <br />,I-I:r OF <br /> <br />. F 'j 5 <br /> <br />,.- <br /> <br />'1-- --- <br /> <br />"':-',/\ -;-E <br />~/.:2,~ .P~ <br /> <br />PART I - ..;i-'PllCANT 'NFC.~'.1ATtON <br /> <br />JC:'~-:;~::;~ -3:j3~~~J~~F~;:;~L;~:~ T/?P-,n1 /~Q..l ~~~~O ~/~P <br /> <br />. PART II - SITE INFORMATION <br />KEy1:0R--D;;:;~1-AG-E CATEGORY (Ust' CJPpropr;;;i;Tettq~"j;; th~-:.cato:sWry" blocks below) <br /> <br />. <br />II. D~RIS REMOVAL <br />b. PROTECTIVE MEASURES <br />c. ROADS AND BRIDGES <br /> <br />d. WATER CONTROL FACILITIES <br />8. PUBLIC 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 (Use map location. oddre.&, etc.) <br />NO. GORY <br /> <br />c <br /> <br />/Jc.e~ss <br /> <br />/Z'o,q 0 7Z> m;~"-v~R. {'/ry ..sEwe.e. <br /> <br />~LA;JT <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />6RAr.,/?C- <br /> <br />/PO;<1Va};<};/ OcJFd 7Or';06".o /J/tlD pJ".SHl':-V 6</T. <br /> <br />{lO/i'/zc,un y t!)P",-/tJ . <br /> <br />{;;XI,ST7AJf.;, VRAo..J;Q0C <br /> <br />~A'{/c-n//C,c5 /AJ n;JD H/A.lt'.nONJvf5,. <br /> <br />IMPACT: "COMPLETE <br />ZAt:> -n;".P' &as~.D - RE'St.N2rAeED gy lawn- &,. '1 kG'r'''''''; /00 <br /> <br />COST ESTIMATE <br /> <br />1'700. <br /> <br /> <br />SITE CATE- LOCATION (Use map IOCGtlon, oddn.., etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />% COMP LETE <br /> <br />COST ESTIMATE <br /> <br />" <br /> <br />SITE CATE- LOCATION (Use map lOCAtion. odd,...., dc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />% COMPLETE <br /> <br />COST ESTIMATE <br /> <br />SITE CATE. LOCATION (Use mop IOCGtion, Gddress, etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />.1i~ <br />?;':~ <br /> <br />IMPACT: <br /> <br />'" COMPLETE <br /> <br />COST ESTIMATE <br /> <br />;~ <br /> <br />NAME OF INSPECTOR <br />Vac..e Ad <br /> <br />AGENCY <br />6:?tb V/v 4./ <br /> <br />PHONE NO. <br />O.fFtCE <br />82<1- St> "" <br /> <br />;1 <br /> <br />I He~E'I_.~t:nq <br />