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<br />~ <br />... <br /> <br />COUNTY <br />4oO'-l:r <br /> <br />FEDERAL GENCY MANAGEMENT AGENCY <br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE <br /> <br />PART I - 'APPLICANT INFORMATION <br />NAME OF L.OCAL CONTACT <br /> <br /> <br /> <br />SHEET...L OF I SHEETS <br />DATE <br />6-2.7-f'1{ <br /> <br />, <br /> <br />::0-.-., p//;o <br /> <br />PART 11- SITE INFORMATION <br />KEV FDA DAMAGE CATEGORY (Use GPproprfDt. le en ~n the "cat.60,...," bloclt. below) <br /> <br /> <br />PHONE NO. <br />7.76- 37#(/ <br /> <br />8. 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 />Go FACILITIES UNDER CONSTRUCTION <br />h. PRIVATE NON-PROFIT <br />I. PUBLIC RECREATION <br /> <br />SITE <br />NO. <br />r:- <br /> <br />CATE- LOCATION (Us. mOJlllocotion. addreu. etc.) <br />GORY <br /> <br />I <br /> <br />Itcc~ r"".,( <br /> <br />-t;- <br /> <br />4/{,1--- <br /> <br />~ .-1- <br /> <br />_-r <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />~,...)' <br /> <br />J-d" /-1- / <br /> <br /><l~ <br /> <br />/7?P",( <br /> <br />~cv-r .....a? W~.-.c"", <br /> <br />IMPACT: <br /> <br />I'~___ call - dzr Ar,r <br />" COMPLETE <br /> <br />yq,,'r ..rrre....-. <br />COST ESTI MATE <br /> <br />~~"'<70' <br /> <br />,t;\> <br /> <br />..;';, <br /> <br />'. <br />" <br /> <br /> <br />SITE CATE. LOCATION (Us. map location, addre... etc.) <br />NO. GORY <br /> <br />;. - ~, <br /> <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />\ <br /> <br /> <br />" COMP LETE <br /> <br />COST ESTIMATE <br /> <br />IMPACT: <br /> <br />SITE CATE- LOCATION (UN rrnr.p Joe4tIon. add"*. .tt.) <br />NO. GORY <br /> <br /> <br />DESCRIPTION OF DAMAGe <br /> <br />IMPACT: <br /> <br />" COMPLETE <br /> <br />COST ESTIMATE <br /> <br />SITE CATE- LOCATION (U.e mGp location. GddreB', etc.) <br />NO. GORY <br /> <br />,~~ <br /> <br />.:::DtNv-~ ...s d ....,.,y r <br /> <br />VA <br /> <br />PHONE NO. <br />OFFICE <br />9'JlIf-?9/Jf <br /> <br />I HOME <br />?--5 5'- 3 '1.?J/ <br /> <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />" COMPLETE <br /> <br />COST ESTIMATE <br /> <br />NAME OF INSPECTOR <br /> <br />AGENCY <br />