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THIS SECTION FOR STATE USE ONLY <br />FEMA- -DR- O Standard HMGP or O 5% Initiative Application <br />? Initial Submission or ? Resubmission <br />O Conforms with State 409 or 322 Plan Eligible Applicant <br />? Conforms with State 404 Plan O State or Local Government <br />O In Declared Area ? Private Non-Profit (Tax ID Received) <br />O Statewide ORecognized Indian Tribe or Tribal Organization <br />Community NFIP Status: O Participating Community ID #: <br />(Check all shat apply) <br />State Application ID <br />State Reviewer <br />(Print Name) <br />? Application Complete <br />Date of Review <br />Project Type(s) <br />? Wind <br />O Flood <br />O Seismic <br />? Other _ <br />? In Good Standing O Non-Participating ? CRS <br />Date Application Received <br />Signed Phone <br />A. To Fill Out This Application: complete all sections that correspond to the type of project proposed <br />General Application Sections pp.I-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 />Critical 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/Commissions <br />4. County/ Counties Orange <br />5. State Legislative district(s) H. 24,26 S. 16 Congressional district(s)-4 <br />6. Tax I.D. Number 56-6000327 FIPS Code (if known) <br />7. Point of Contact <br />?Ms. 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 NC 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 Specialist Telephone 919-968-2050 Fax 919-968-4066 E-mail <br />egriffin@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 T° `f Signature <br />NOTE: If your project is found eligible ?t tl appro ed for funding, work must begin within 90 days of the <br />obligation of funds <br />81