THE LORAIN COUNTY OFFICE OF EMERGENCY MANAGEMENT AND HOMELAND SECURITY 322 GATEWAY BOULEVARD NORTH, ELYRIA, OHIO 44035 MAJOR DAMAGE ASSESSMENT FORM Name: _____________________________________________________________________________________________ Address: _____________________________________________________________________________________________ Phone: _______________________ (Home) _______________________ (cell) _______________________ (other) CHECK ONE OR MORE OF THE FOLLOW: Damage: ____ 18 inches of water or more on the first floor living space or water that covers Electrical outlets on the first floor ____ Home with a basement where the water level has compromised the structural integrity of the home (basement walls) ____ Uninhabitable. Will take thirty (30) or more days to repair. Do you have flood insurance? ____ yes ____ no RETURN THIS PAGE TO THE LORAIN COUNTY OFFICE OF EMERGENECT MANAGEMANT AND HOMELAND SECURITY AS SOON AS POSSIBLE. YOU CAN EMAIL THE FORM TO: [email protected] FAX: 440-322-1272. THE FORM CAN BE FILLED OUT ON YOUR COMPUTER BY PUSHING NUMLOCK AND INSERT. THE LORAIN COUNTY BOARD OF COMMISSIONERS LORI KOKOSKI TED KALO TOM WILLIAMS
Posted on: Sat, 17 May 2014 18:59:05 +0000
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