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<br /> <br />'. <br /> <br />~ <br /> <br />SHEET <br /> <br />OF <br /> <br />SHEETS <br /> <br />FEDERAL EMERGENCY MANAGEMENT AGENCY <br />PRELIMINARY DAMAGE ASSESSMENT SITE ESTIMATE <br /> <br />PART I APPLICANT INFORMATION <br />NAME OF LOCAL CONTACT <br /> <br /> <br /><it <br />PART II SITE INFORMATION <br />KEY FDA DAMAGE CATEGORY (V.e approprl4te ktte,.. i" the "category" block. below) <br /> <br /> <br />e. OeBRIS REMOVAL <br />b. PROTECTIVE MEASURES <br />c. AOADS AND BRIDGES <br /> <br />d. WATER CONTROL FACILITIeS <br />e. PUBLIC BUILOING6 <br />f. PUBLIC UTI L1T1ES <br /> <br />g. FACILITIES UNDER CONSTRUCTION <br />h. PRIVATE NON-PROFIT <br />I. PUBLIC RECREATION <br /> <br />SITE CATE- LOCATION (Vae map Jaeotian. ~e~ /.. A . L r?: <br />NO. GORY r.s/anc/ 4t!r-es Si "K"ec~rlb11 nreC( (:IT J- / '0 <br /> <br />/ B <br />DESCRIPTION OF DAMAGE L /' / /. -= / f /. / L 1/_ <br />13rea~& cWKe:s t:lraw"c/-Ihe f}eY"/l'>1er-er' Of'1'/l.R. rarJ::.. .5 F.. n1i^' -raTer l/flr <br />a/JdJf!- 4c:oo )../1'1. FI.. ""1?e5 h,rah.;n, neecled al a6x.t1 ~ stlt!:s .. <br /> <br /> <br />IMPACT: <br /> <br />F/oac!;11 of 1?/~ sf; '~'pIA ~wer }j ,,{ fk P::W-k. <br /> <br />% COMPLETE <br /> <br />o <br /> <br />J?ST ESTIMATE <br />1'> ~~ 000 <br /> <br />SITE CATE- LOCATION (U.e map location_ addre., etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />" COMPLETE <br /> <br />COST ESTIMATE <br /> <br />SITE CATE. LOCATION (Uae map location, addJ"ft.. etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />{' COMPLETE <br /> <br />COST ESTIMATE <br /> <br />.' <br /> <br />SITE CATE- LOCATION (Use map location, addre... etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />% COMPLETE <br /> <br />COST ESTIMATE <br /> <br /> <br />NAME OF INSP~CT?.f <br />Alem tW&d~/fflro <br /> <br />ef'/' <br /> <br />AGENCY!,.- 0 <br />0",/ <'T /#oler r:-e~'O'oe~ <br />COr:_ ~ of' el4<Jl11~rs. <br /> <br />PHONE NO. <br />OFFICE "1'fS"-~S-1 HOME <br />'/(, ftkJ..!S7 7 <br />