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APPLICATION FOR FLOOD HAZARD MITIGATION GRANT ASSISTANCE <br />Local Government Unit(s) Date <br />Address Zip Code <br />Contact Person <br />( ) <br />Title Phone Number <br />Total Estimated Project Cost Grant Amount Requested <br />1. Description of the Flooding Problem <br />What is the location, nature, extent, frequency, and severity of flood <br />problems in your local government? Include numbers of lives lost or <br />threatened and the number of homes, businesses and public facilities such <br />as sewers and roads at risk or damaged. Has the area been included in a <br />Presidential Flood Disaster Declaration? If so, when? What lakes, <br />streams, ditches, ponding areas, groundwater aquifers or storm sewers are <br />causing the flooding problems? <br />PAGE -12- <br />