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<br />FEDERA <br />PRELIMINA <br /> <br />ERGENCY MANAGEMENT AGENCY <br />DAMAGE ASSESSMENT SUMMARY <br /> <br />PART I - APPLICANT INFORMATION <br />NAME OF LOCAL CONTACT <br />~ <br /> <br /> <br />C~NTY <br />Ko u r-r <br />POPULATION <br /> <br /> <br /> <br />PHONE NO. <br />!',}Cf'-tJICJ? <br /> <br />CATE- NO, OF <br />GORY SITES <br /> <br />MAINTENANCE BUDGET <br />ael.nce $ Approved $ Bal.nce $ <br />PART II - COST ESTIMATE.SUMMARY (COMPUTE SITE ESTIMATE BEFORE SUMMARIZING BELOW) <br />POTENTIAL LOCAL FUNDS FOR RECOVERY <br />FUND/ACCOUNT _' AVAILABLE BALANCE <br /> <br />DATE FY BEGINS <br /> <br />TYPES OF DAMAGE <br /> <br />COST ESTIMATE <br /> <br />c. <br /> <br />I <br /> <br />Ro;QOt<HJ '/ S":,,er,,,e /"uC7 <br /> <br />"7 cJO . DO <br /> <br /> <br />TOTAL <br /> <br />'cftJ.oo <br />PART 111- DISASTER IMPACTS (USE SEPARATE SHEETS IF NECESSARY) <br /> <br />A. GENERAL IMPACT <br />1, Identify and describe damages which constitute a health and/or safety hazard to the general public. <br /> <br />IJo <br /> <br />W, 2. Population adversely affected directly or indirectly by the loa of public facilities or damages.- <br />::r "..... <br />:_'l <br /> <br />/lJj IJC <br /> <br />3. What economic activities ere adversely affected by the loss of public facilities or damages? <br /> <br />I!)tJ/UC <br /> <br />B. RESPONSE CAPABILITY: Can the applicant respond and recover from the damages quickly and without degradation of public services? Describe. <br /> <br />Yes <br /> <br />C. IMPACT ON PUBLIC SERVICES IF DECLARATION 15 NOT MADE: e.g., Deferral of permanent repairs, impact on ongoing services and capital <br />improvements, etc. Describe. <br /> <br />IJ:wc <br /> <br />N~~J.! ~PJtTOR <br />~g/l /oJ. <br /> <br />PH'> <br />FEMA Form 90-80. JAN 84 <br /> <br /> <br />PHONE NO;#2<J'-S?>/t? <br />23-;/-4'1'..3, <br />