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<br />SHEETOP SHEETS
<br />DATE
<br />6 ' ;} '?- 8
<br />
<br />ENCY MANAGEMENT AGENCY
<br />AGE ASSESSMENT SITE ESTIMATE
<br />
<br />PART 1- APPLICANT INFORMATION
<br />NAME OF LOCAL CONTACT
<br />ROA-J }J,LK...
<br />
<br />PART II SITE INFORMATION
<br />KEY FOR DAMAGE CATEGORY (UH appropriate,..".,.. In tIN "cate6ory" bloc.. bdo....)
<br />
<br />PHONE NO.
<br />S 7 d' - 5'(7 ;;}
<br />
<br />a. 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 />",-,,2>
<br />
<br />g. FACILITIES UNDER CONSTRUCTION
<br />h. PRIVATE NON-PROFIT
<br />I. PUBLIC RECREATION
<br />/ C ~A""C~ CA>e.pk.
<br />
<br />SITE CATE- LOCATION (Uu mQP location. odd,...", -'c.) CdlQ n-ry
<br />NO. GORY
<br />.:l 5 C-
<br />
<br />:2t!-
<br />
<br />DESCRIPTION OF DAMAGE
<br />
<br />(! ;L.l
<br />
<br />13p;';ml
<br />'p4-r /A/
<br />A4/-l T,
<br />
<br />S"'4-7J,
<br />4/ "'~5'
<br />
<br />8/P,'<I'l-P 4b",It-'-'f'..v1- &vAsA..."
<br />C<//14 j>/tRer-./lt?"~vP/ !5LJs-p l3.-vd
<br />
<br />CJ 47,
<br />
<br />-f/ P t.</
<br />
<br />R,f ~ RAp A/P#5
<br />~ II A 5jJh.<t,tT
<br />
<br />IMPACT:
<br />
<br />/),"i A'''T
<br />
<br />~
<br />/;/I!r //
<br />
<br />~
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />S/T-f?,
<br />
<br />85
<br />
<br />.'f-
<br />
<br />j,
<br />
<br />'1t
<br />
<br />SITE CATE- LOCATION CU.. map location. 1lJdd,..-. etc.) ~..Ar-r "ocypJ'AS
<br />NO.. GORY ,,-.; ~"'....,~ ~"4t> i}.H' A'" C-4;J,pl>lf'.ol
<br />:U.6.' <,
<br />~~ll<:RIPT!O~()F ()~"'~~'!\;f"!t1!J"/.o\"""/,07)" ..IYI?:~/ A',y/d' __.4 ;P.e C'.,Jvs,,f
<br />,d~".7f":";'::,rh/~;;''"f!./_'''_'/I'''Y 1_ 47e-/AlL... 13~id?"..
<br />. r~... e... li,.p u..-AS dl'/RClKI_",r../",. do!; ~.....t -'-q" 'l- OC
<br />
<br />(!/?,,"K S6l1'c"r
<br />C' R~"/C e,h 1e;"....,J
<br />
<br />
<br />/tjt:!t?Cl
<br />R..",p'''/Y
<br />
<br />'.". /<,>,;
<br />i:'.
<br />
<br />C''''_.I'/,trr~
<br />4.-.<1 j" ~ ....,:7
<br />.
<br />
<br />
<br />~
<br />::10 ~.....t- ......,df'
<br />
<br />k
<br />;"
<br />''1
<br />~
<br />rj
<br />
<br />IMPACT:
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />. 1.) 'c. rl . A/t7 T
<br />
<br />t:--;rsrT
<br />
<br />.s>'l~.."
<br />
<br />j::-'~ .-
<br />
<br />c9
<br />
<br />
<br />SITE CATE. LOCATION (U.......1ocloIfcm, ad_ ''''.1
<br />NO. GORY
<br />
<br />. .~--
<br />
<br />DESCA'PTION OF DAMAGE
<br />
<br />IMPACT:
<br />
<br />% COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />SITE CATE- LOCATION (Use mop location. odd,..., etc.)
<br />NO. GORY
<br />
<br />:k DESCRIPTION OF OAMAGE
<br />
<br />i
<br />:j
<br />,
<br />
<br />.
<br />,
<br />'r:
<br />
<br />IMPACT:
<br />
<br />" COMPLETE
<br />
<br />COST ESTIMATE
<br />
<br />NAME OF INSPECTOR
<br />R,-' S I""'.A ~
<br />
<br />/ ," I _ 1/"., . 'r-
<br />
<br />AGENCY
<br />{:Ht<->A
<br />
<br />,. ^ - "
<br />
<br />PHONE NO.
<br />OFFICE
<br />P.J",-~"']j'
<br />
<br />I HOM"-
<br />~93-- 9676'
<br />
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