Orange County NC Website
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r, <br />FEMM -DR- O Standard HMGP or O 6% Initiative Application 0 Application Complete <br />0 Initial Submission or O Resubmission Date of Review <br />O Conforms with State 409 or 322 Plan Eligible Applicant Project Types) <br />O Conforms with State 404 Plan O State or local Goverment 0 Wind <br />Cl In Declared Area 0 Private Non -Profd (Tax ID Received) O Flood <br />0 Statewide ORecognized Indian Tribe or Tribal Organization 0 Seismic <br />ornrnuall 'thatF� ply) atus: 0 Participating Community ID #I <br />(Chea State Application ID <br />0 Other _ <br />0 In Good Standing 0 Non - Participating 0 CRS <br />Date Application Received <br />State Reviewer Signed Phone e <br />(Print Name) <br />A. To Fill Out This Application: complete all sections that correspond to the type of project proposed <br />General Application Sections pp. 1-10: All Applicants must complete these sections <br />Maintenance Agreement p. 11: Any applications involving public property, or public ownership, or management of <br />property <br />Acquisition Worksheet pp. 12-13: Acquisition Projects only -- one per structure <br />Elevation Worksheet pp. 14-15: Elevation Projects only -- one per structure <br />Ckkkal Public Facility Worksheet pp. 16-17: Critical Public Facility Projects only <br />Drainage Worksheet p. 18: Drainage Projects only <br />B. Applicant Information <br />1. Title / Brief Project Descriptive Summary Orange County Hazard Mitigation Project <br />2. Applicant (Organization) Orange County Emergency Management <br />3. Applicant Type: <br />X State or Local Government ❑ Recognized Indian Tribe ❑ Private Non -Profit Organizations <br />❑ Special District/Public Utilities/Commissiotks <br />4. County / Counties Orange <br />5. State Legislative district(s) H. 24.26 S. 16 Congressional district(s)_A <br />6. Tax I.D. Number 56- 6000327 FIPS Code (if known) <br />7. Point of Contact <br />OMs. X Mr. ❑Mrs. First Name Nick Last Name Waters <br />Title Emergency Management Director <br />Street Address P.O. Box 8181 <br />City Hillsborough State Zip Code 27278 <br />Telephone 919- 968 -2050 Fax 919- 968 -4066 E -mail Address nwaters @co.oran eg nc.us <br />8. Alternate Contact: ❑Ms. XMr. Mrs. First Name Eric Last Name Griffin <br />Title Emergency Management SReoialist Telephone 919 -968 -2050 Fax 919 - 968 -4066 E -mail <br />l;&dffin @co.oran eg nc.us <br />9. Designated Agent <br />❑Ms. XMr. []Mrs. First Name John Last Name Link <br />Title County Manager Telephone 919- 732 -8181 Fax 919- 644 -3004 <br />Street Address P.O. Box 8181 <br />City Hillsborough_ State NC Zip Code 27278 <br />Email Address ilink@co.oran eg nc.us <br />Date �� `f Signature <br />NOTE: If your project is found eligible appro ed for funding, work must begin within 90 days of the <br />obligation of funds <br />