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<br /> <br />~ <br />FEDERAL .AGENCY MANAGEMENT AGENCY <br />PRELIMINARY dlrMAGE ASSESSMENT SITE ESTIMATE <br /> <br />PART I - APPLICANT INFORMATION <br />NAME OF APPLICANT NAME OF LOCAL CONTACT <br />Cal..l~\ <br /> <br />SHEET ~ OF ~ SHEETS <br />DATE <br />":3"4}~C ::\.(;, M- <br /> <br />PART II - SITE INFORMATION <br />KEY FOR DAMAGE CATEGORY (UM tJPProprlGteIeU.",'n the "cat.6ory" bloclt. below) <br /> <br /> <br />.. DEBRIS REMOVAL <br />b. PROTECTIVE MEASURES <br />c. ROADS AND BRIDGES <br /> <br />d. WATER CONTROL PACILITIES <br />.. PUBJ-IC BUILDINGS <br />f. PUBLIC UTILITIES <br /> <br />g. FACILITIES UNDER CONSTRUCTION <br />h. PRIVATE NON-PROFIT <br />L PUBLIC RECREATION <br /> <br />SITE CATE. L.OCATlON (U.. naG locoHon. Gddrw... etc.) <br />NO. GORY <br /> <br /> <br />Q\\"'1 <br /> <br />~t= <br /> <br />R A.'N.c..6L't" <br /> <br />\0 \:> Res\: E:c. \" <br />PRo" I ~~ <br />f<E'EUIL., <br /> <br />~ ,,'-\ 'A\2....~ 'f--Q..o'l<\ ~u~\""G-R. f:-L~ IN-G... <br />S'A-'f'-.l. ~ (6't'i<&.-S (SI'Is-N-D FQl~ Sfl-ND ~C.,",rMGo... <br />/)),t:E 10 P~TE?;C-r 6/2..1:99 FJ2lJ};.f R~o~ /N~. <br /> <br />IMPACT: <br /> <br />Ce>s7 ~ r 1/ b-;1.f <br />~ j) ~ 1>1J1t- Cz.C <br /> <br /> <br />" COMPLETE <br /> <br />q(:,~. <br /> <br />COST ESTI MATE <br /> <br />ffo, 00 cJ <br /> <br />SITE CATE- LOCATION (U.. map loNHo... oddrlNI,. _Ie.) <br />NO. GO"Y <br />/0 CI"\'-f C'P M ~~ \LS12.., <br />D RIPT OF DAMAGE <br />e=t1~~N C-'f f2..CP17/f?.. Lr-t6~K. '"76 sAvi#BiZ../btO-c'.' <br />,4-~tJ/MeNl 51 SI9-Nh $J4~'~ oP6?2I'J-rroN, <br /> <br />Ce.s:., P ~J.'IJ}e /) fa'-j ;!J. () ~ c . <br /> <br />R..f:"'Pflf~ <br /> <br />.,;; <br /> <br />., <br /> <br />IMPACT: <br /> <br />" COMPLETE <br /> <br />COST ESTIMATE <br /> <br />/0 ~ /)ra.J7Jfl-~ <br /> <br />qo<of~ <br /> <br />:,~C) <br /> <br /> <br />SITE CATE- LOCATION fU.. mq 1ocG:1fo1l. Nd...... etc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: <br /> <br />" COMPLETE <br /> <br />COST ESTI MATE <br /> <br />SITE CATE- LOCATION (UH mop loeGtlon. odd,...,. dc.) <br />NO. GORY <br /> <br />DESCRIPTION OF DAMAGE <br /> <br />IMPACT: '" COMPLETE <br /> <br />COST ESTIMATE <br /> <br />NAME OF INSPECTOR <br />o \.-1 (' \ <br /> <br /> <br />~l..v' ~~ v' <br />AGENCY <br /> <br />- 02-7 ~ <br /> <br />n ,... 1-. <br /> <br />PHONE NO. <br />OFFICE <br />t! ~<-:>"::>~ <br /> <br />I HOME <br />