HomeMy WebLinkAboutResidential Flood Questionnaire-HandoutCounty of Hawaii
DEPARTMENT OF PUBLIC WORKS
RESIDENTIAL FLOODING QUESTIONNAIRE
To assist us in better identifying special flood hazard areas, please complete the following questionnaire
and mail to:
Department of Public Works
Engineering Division
101 Pauahi Street, Suite 7
Hilo, Hawai‘i 96720
Street address of your home:
Years you lived at the above address?
Years
Do you have flood insurance? Yes No
Describe your flood issue:
Did you live at the above address during the Nov. 28 or Dec. 5 & 6, 2007 storm? Yes No
Was
the above address flooded during the Nov. 28 or Dec. 5 & 6, 2007 storm? Yes No
If item 6 is “yes,” please indicate in the table below, how high the water level rose relative to the
first floor of your home (A reasonable estimate, based on your memory is acceptable).
Water Level Rise Relative to First Floor
Below
-or-
Above
Feet
Inches
Feet
Inches
Has the above address been flooded before? Yes No
If item 8 is “yes,” in the table below, please provide us with the date(s) flooding occurred and the water level rise relative to
the first floor of your home (A reasonable estimate, based on your memory is acceptable).
Flooding Occurred
Water Level Rise Relative to First Floor
Below
-or-
Above
Month
Year
Feet
Inc
hes
Feet
Inches
(Fold on dotted line and seal with tape.)
Postage
Required
DEPARTMENT OF PUBLIC WORKS
ENGINEERING DIVISION
101 PAUAHI STREET, STE 7
HILO HAWAII 96720
RESIDENTIAL
FLOODING QUESTIONAIRE
(Fold on dotted line and seal with tape.)