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<br />
<br />.----l- ;"DFPAL~;:"<'YW:"'GEMENT AGENCY
<br />."<EUMINARY O"'GE ASSESSMENT SITE ESTlMA fE
<br />--,-----
<br />PART I - APPLICANT INFORMATION
<br />NAME OF LOCAL CONTACT
<br />/e..-. MccA",t .
<br />
<br />...-.
<br />
<br />SHEETn_L OF _ .tSHEETS
<br />
<br />I DATE
<br />c; - 27-,6'--/
<br />
<br />N-AME OF APPLICANT
<br />/<7""'" ",/, h"a. 1q"'b;7
<br />
<br />PHONE NO.
<br />Z7C,-:37<;1/
<br />
<br />PART II - SITE INFORMATION
<br />Y FDA DAMAGE CATEGORY (Ule appropriate letteT'lin the "catE-Iory" block. below)
<br />
<br />.
<br />.. DEBRIS REMOVAL
<br />b. PROTECTIVE MEASURES
<br />c. ROADS AND BRIDGES
<br />
<br />d. WATER CONTROL. FACILITIES
<br />e. PUBLIC BUILDINGS
<br />f. PUBLIC UTILITIES
<br />
<br />1iI- FACILITIES UNDER CONSTRUCTION
<br />h. PRIVATE NON-PROFIT
<br />I. PUBLIC RECREATION
<br />
<br />sITe CATE- LOCATION (U.e mop location. add,..... etc.)
<br />NO. GORY , ,/. /'L /L / / ./
<br />I Vc.. AC--'?",/h6'y~k"'.k..... k_?"W7".,,L //Ifl"'/ t?# .":>/7e/?tIn.?a.e/ -2/n//emv~/as..
<br />
<br />DESCRiPTION OF DAMAGE"
<br />"f/---~ ~a",~k. 0'&.:> ~..es 4.> ~~q,,~r ~ ~aCCe$s;-oJ 7he~../ '-':'4S
<br />,,..~.t'w 6/ 14.. Xar", w;l"a/.5.. C"d,<<;-d <2""<y ab",~/ ,:t 3-/1 ""/~ ,6t:M~ (t:[,L 4/",,/ $~'~
<br />~p/- ClbPU/ /: / / ~/h kAt"",,,,,,) t7rer e:zbOUr. ;300,4e./ ,;, 4-M~ ",,ca,,,c/ ~ ~ao7t- "rC ~
<br />/a,,/ .6U'/d-;., . A6 ~ e n, roJ- '
<br />IMPACT:
<br />CY~/'7 ch~"l?lZcI 4.y-""'7r ,.e.ac/,;- ~~~-:.
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />o
<br />
<br />~/qa>o
<br />
<br />SITE CATE- LOCATION (UM majJ ~tIoIJ. odc:I7ua. ete41
<br />NO. GORY
<br />
<br />f,~19&-1;., 1~~:,qJJ2'cj{#,g.S( CI!c.s.J,,J(,! Ot"- JJR'{ . &ei~
<br />DESCRIPTION OF D AGE;:1.;1':;*.;', \- ~.t~;-""'.<:~<f"tf;:..< J " ."
<br />',' . 'n:..:a-.:....'...~,.,,~m.,.':r-.~ .','"a.. <;;.....'q".;."."",ii','
<br />. f7'-C"~;'ru''''''' . #;v G,;ii: S,ge. ~F8L.f)~E."(.tJJ;jk J);'~
<br />
<br />I
<br />
<br />c.
<br />
<br />... ,'.
<br />-roiif-[c!!f" ~,~
<br />
<br />IMPACT, 9bvl ~ fl-(.(tss to/tJll:IH
<br />!>f:rlJlJ,e. .UN'f'L.. Au
<br /><.-e" , ., ,,-_,
<br />SITe CATE- LOCATlONCU.. ......li>cotlo...:........... .t~,1
<br />NO: - GORY ~ ';-
<br />
<br />~ :xJ1J-r'" c,J 3te.f) Sf. RB:ioJ,~
<br />,~ - I
<br />~ NEw .f)~CJQNG CtJI11fl:.lf!;P .
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />/00
<br />
<br />.6""000
<br />
<br />DESCRIPTION OF DAMAGe
<br />
<br />IMPACT:
<br />
<br />% COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />SITE CATE- LOCATION (UH map locallon. odd...... de.)
<br />NO. GORY
<br />
<br />DESCRIPTION OF DAMAGE
<br />
<br />IMPACT:
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />NAME OF INSPECTOR
<br />Jt?/7a.,t~",,, AI. yG~
<br />:no/... p!j~
<br />
<br />AGENCY
<br />F#VA C",/p"",c/o Z//V"/S/"."
<br />/
<br />/' /_ _ / -".../ /'// n.../.. ~
<br />
<br />PHONE NO,
<br />
<br />OFFICE ~~:-~<<3~1 HOM"?:3.-5,:,=~
<br />
<br />-
<br />
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