Flooding Survey

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* 1. What types of flooding did you experience?

Yard Flooding

Street Flooding (Adhacent to or limiting access to your property)

Flooding of the residence

Flooding of non-residential structures (shed, detached garage, etc. - please explain in "Other" below)

Other (Please describe) or use this box to list other flooded streets in your area

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* 2. If you had damages that required repairs, please estimate the cost in dollars for damages incurred. Specify date of storm and dollar amount for each event.

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* 3. If you had damages that required debris removal, please estimate the dollar amount you paid for debris removal. Specify date of storm and dollar amount for each event.

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* 4. If you experienced flooding inside your home during a storm event, please specify the depth of flooding in inches or feet and the length of time in hours or days.

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* 5. Do you have photos of flood waters or damage to your home or property? (If you are willing to share those photos, please e-mail copies to cindy.lieberman@brevardcounty.us OR MAIL to Brevard County Natural Resources Management, ATTN: Cindy Lieberman 2725 Judge Fran Jamieson Way Suite A-219, Viera, Florida 32940.

YES

NO

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* 6. THANK YOU FOR TAKING THE TIME TO ANSWER THIS SURVEY. At a minimum, please supply us with you address so we can map flooded areas. Your name, e-mail and daytime contact information is also greatly appreciated so we can contact you if clarification is needed. Please Note: Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.

NAME:

ADDRESS:

E-MAIL:

ALTERNATE CONTACT: