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<br />CATE. NO. OF <br />GORV SfTU <br /> <br />ERGENCY MANAGEMENT AGENCY <br />bAMAGE ASSESSMENT SUMMARY <br />PART I APPLICANT INFORMATION <br />NAME OF APPLICANT NAME OF L.OCAL CONTACT <br />~f/"11 ~ . .--m,;< (....- t? <br />TOTAL BUDGET MAINTENANCE BUD T <br />ApprOY..:lS &.Ience $ Approved' Belenee $ <br />PART 11- COST ESTIMATE-SU_RY (COMPLETB BITB BSTIMATB BEFOBE SUMMARIZING BELOW) <br />POTENTIAL LOCAL FUNDS FOR RECOVERY <br /> <br />FEDE <br />PRELlMI. <br /> <br /> <br />PAGE 1 OF LPAGI <br /> <br />. <br /> <br />DATI= <br /> <br />o-::J7-yl,( <br /> <br />-COUNT"'" <br />r?ooJf t- <br />POPULATION <br /> <br />PHONE NO. <br />n 9- C7/,y,j <br /> <br />DATE FY BEGINS <br /> <br />TYPES OF DAMAGE <br /> <br />COST ESTIMATE <br /> <br />FUND/ACCOUNT <br /> <br />_' AVAILABLE BALANCE <br /> <br />r <br /> <br />/ <br /> <br />1fC&~ o"..,L <br /> <br />.f <br />1t1o, <br /> <br />. <br /> <br />':""';{~'X<',,, <br />""'i:!!;"",,,...,.C;'~r <br />'~~,tJ1"j'\~-"':-;::;-. <br /> <br /> <br /> <br /> <br />TOTAL <br /> <br />PART III - DISASTER IMPACTS (USE BE"ARATE..~ <br /> <br />A. GENERAL IMPACT <br />1. Identify and describe damages which constitute a h4 <br /> <br />public. <br /> <br />2. Populnion 8dverse4V effected directlV or indirectly <br /> <br />'iio,:~.\",~~; ,:--.t ~-;r:;....,', <br /> <br />3. Wha economic ectivitfes ant adversely affected by the IOIS of public facilities or darn8ges7 <br /> <br />B. RESPONSE CAPABILITY: Can the applicant respond and recover from the damages Quickly and without degradation of pUblic services? Describe. <br /> <br />/~ <br /> <br />C. IMPACT ON PUBLIC SERVICES IF DECLARATION IS NOT MADE: e.g., Def.rral of permanent repeirs~ irnpect on ongoing services and capital <br />impro~ents. etc. Describe. <br /> <br />/Vr; ...;...,~. e t-. <br /> <br />N~.-:NSPECTOR <br />(c:L----.s~"",/f- <br /> <br />AGENCY <br />C/',4- <br /> <br />PHONE NO. <br />[fIlJf -J 9/41 <br />