HomeMy WebLinkAboutNonresidential Flood Questionnaire-HandoutCounty of Hawaii
DEPARTMENT OF PUBLIC WORKS
NONRESIDENTIAL 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
1. Street address of your business:
2. Year your business began at
the above address? Year
3. Do you have flood insurance? Yes No
4. Briefly describe the nature of your business.
5. Please indicate the number of full time,
part time and total people you employ.
+ =
Full Time Part Time Total Employees
6. How many shifts are there in your daily operation? shifts
per day
7. Describe your flood issue.
8. Was your business closed due to the Nov. 28 or Dec. 5 & 6, 2007 storm? Yes No
9. If item 8 is “yes,” how many days were you closed?
Days
10. Was your business temporarily relocated to another location due to the
Nov. 28 or Dec. 5 & 6, 2007 storm? Yes No
11. Was your business flooded
during the Nov. 28 or Dec. 5 & 6, 2007 storm? Yes No
12. If item 11 is “yes,” please indicate in the table below, how high the water level rose relative to the first floor of your
business (A reasonable estimate, based on your memory is acceptable).
Water Level Rise Relative to First Floor
Below
-or-
Above
Feet
Inches
Feet
Inches
13. Has the above address been flooded before? Yes No
14. If item 13 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 business (A reasonable estimate, based on your memory is acceptable).
Flooding Occurred
Water Level Rise Relative to First Floor
Below
-or-
Above
Month
Year
Feet
Inches
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
NONRESIDENTI
AL FLOODING QUESTIONAIRE
(Fold on dotted line and seal with tape.)