INDIVIDUAL ASSISTANCE STREET SHEET Page ____ of ____ County Jurisdiction Name Date Assessor's Name/Phone Number Type of Depth of Local Preliminary State Location Status Area Insurance Structure Water Determination Use Only (Street Address, Apt/Condo, Complex, MH Park) D Maj Min A SF ____ Basement Flood ____ __ ft __ in MH ____ Homeowners ____ Own ___ First Floor __ ft __ in Apt ____ Rent ___ Renters ____ Condo ____ Crawl Space __ ft __ in Sewer B/U Rider ____ Business ___ Comments: SF ____ Flood ____ Basement __ ft __ in MH ____ Homeowners ____ Own ___ First Floor __ ft __ in Apt ____ Rent ___ Renters ____ Condo ____ Crawl Space __ ft __ in Sewer B/U Rider ____ Business ___ Comments: SF ____ Flood ____ Basement __ ft __ in MH ____ Homeowners ____ Own ___ First Floor __ ft __ in Apt ____ Rent ___ Renters ____ Condo ____ Crawl Space __ ft __ in Sewer B/U Rider ____ Business ___ Comments: SF ____ Flood ____ Basement __ ft __ in MH ____ Homeowners ____ Own ___ First Floor __ ft __ in Apt ____ Rent ___ Renters ____ Condo ____ Crawl Space __ ft __ in Sewer B/U Rider ____ Business ___ Comments: SF ____ Flood ____ Basement __ ft __ in MH ____ Homeowners ____ Own ___ First Floor __ ft __ in Apt ____ Rent ___ Renters ____ Condo ____ Crawl Space __ ft __ in Sewer B/U Rider ____ Business ___ Comments: Rev. 5/2015 Total for page:
INDIVIDUAL ASSISTANCE STREET SHEET Page ____ of ____ County Jurisdiction Name Date Assessor's Name/Phone Number Location (Street Address, Apt/Condo, Complex, MH Park) Type of Structure Status Area Depth of Water Insurance Local Preliminary Determination State Use Only D Maj Min A SF ____ MH ____ Apt ____ Condo ____ Business ___ Own ___ Rent ___ Basement __ ft __ in Flood ____ Homeowners ____ Renters ____ Sewer B/U Rider ____ First Floor __ ft __ in Crawl Space __ ft __ in Comments: SF ____ MH ____ Apt ____ Condo ____ Business ___ Own ___ Rent ___ Basement __ ft __ in Flood ____ Homeowners ____ Renters ____ Sewer B/U Rider ____ First Floor __ ft __ in Crawl Space __ ft __ in Comments: SF ____ MH ____ Apt ____ Condo ____ Business ___ Own ___ Rent ___ Basement __ ft __ in Flood ____ Homeowners ____ Renters ____ Sewer B/U Rider ____ First Floor __ ft __ in Crawl Space __ ft __ in Comments: SF ____ MH ____ Apt ____ Condo ____ Business ___ Own ___ Rent ___ Basement __ ft __ in Flood ____ Homeowners ____ Renters ____ Sewer B/U Rider ____ First Floor __ ft __ in Crawl Space __ ft __ in Comments: SF ____ MH ____ Apt ____ Condo ____ Business ___ Own ___ Rent ___ Basement __ ft __ in Flood ____ Homeowners ____ Renters ____ Sewer B/U Rider ____ First Floor __ ft __ in Crawl Space __ ft __ in Comments: Rev. 5/2015 Total for page:
Hamilton-County-Local-EOP-Template-14-Annex-N-The-Disaster-Recovery-Function.docx