Laserfiche WebLink
<br /> <br />. - <br /> <br />~ <br /> <br />STATE OF COLORADO <br />DAMAGE SURVEY REPORT <br />DISASTER RESPONSE AND RECOVERY <br /> <br />3, DECLARATION NO, <br /> <br />2. APPLICANT (State Agency, County, City. etc.) <br />I OF /lLA/J'7ashl. <br />7~ ~RK CATEGORY ,uX" Applicable Box) DSR NO. <br />~MERGENCY 0 A 0 B I /t 4 <br />o PERMANENT 0 COD 0 E 0 FOG 0 H 0 I : t- 0- <br />8. DAMAG ED F ~CI L1TI ES (Location. identification and description) <br />C:-~OSIOA/ of Levee- NC?9R ~tXr C?od~.sc: <br />@ SIre #2.., <br /> <br />I PANO. <br />I <br /> <br />4, INSPECTION DATE <br />- 3/-35 <br />5, WORK ACCOMPLISHED BY <br /> <br />o CONTRACT <br />o FORCE ACCOUNT <br /> <br />,- TO COLORADO DIVISION OF DISASTER EMERGENCY SERVICES <br /> <br />6. PERCENTAGE OF WORK <br />COMPLETEO TO DATE <br /> <br />% <br />BA. FACILITY IN OR AFFECTS <br />FLOOD PLAIN OR WET LANDS <br /> <br />DYES <br /> <br />oNO <br /> <br />9, DESCRIPTION OF DAMAGE . <br />E,eas,,;'/l/ dF 8./sr"lVa LGlI6i!f &C/No/ ft C!/~ #,Qut:.e-.o /A/ <br />~o do~ 77cu~ LoA'LlS oP 8/2J:>K6IV a.ue.Re~ ,<1& ,.t?~-Rr <br /> <br />10, SCOPE OF PROPOSED WORK <br />Remove e,A"~.Rde /11ak/'/"Q,,(,.. ,AM'; SntJeA::-tP;/e dA./ s~.,...~, ~L. oV <br />FILL /J1/1re7Z/,I(lL y -ee:srlA/>E L-E7/~ Al~/~~/?1,.".vr ro 377>1 s~,,"E <br />~ E-05€ (S/')C{//J~e) 8~ok'<!'A./ a,1VL"'~""e ,4s ~A?.", ..4N~ jPcA et!!: <br />/J~~/~MMtJL.- .Ry -R'r. <br /> <br />QUANTITY <br />(.1 <br /> <br />UNIT <br />Ib) <br /> <br />11. ESTIMATED COST OF PROPOSED WORK <br />MATERIAL AND/OR DESCRIPTION <br />CeI <br /> <br />UNIT PRICE <br />Cd) <br /> <br />COST (dollars) <br />Cel <br /> <br /> <br /> <br /> <br />. <br /> <br /> <br />12. <br /> <br />I <br />I <br />INSPECTOR (Signature. Agency, date) <br /> <br />TOTAL,- $ /. <br /> <br />ELIGIBLE TTACHMENTS <br />o YESo NO <br />CONCUR ATTACHMENTS <br />DYES 0 NO <br />CDNCUR ATTACHMENTS <br />oYESo NO <br />qeVI EW (Initials and date) <br /> <br /> <br />13. RECOMMENDATION BY <br /> <br />14. CONCURRENCE IN REPORT BY STATE INSPECTOR (Signature, Agency, date) <br /> <br />15. CONCURRENCE IN REPORT BY LOCAL REPRESENTATIVE (Signature, Agency, date) <br /> <br />16, <br /> <br />lEVI EW (Signature, Agency, date) <br />