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INDIAN RIVER FARM_ S WATER CONTROL DISTRICT <br /> 7305 4th Sireet <br /> Vero Beach, Florida 32968 <br /> (772) S02-2141 <br /> APPLICATION FOR CONNECTION TO OR USE OF DISTRICT FACILITIES <br /> Date : __ o s 3 { No. <br /> A . Applicant Information : Name : kr4 g�iva C4 <br /> Address : 10, 50 ffllf� <br /> 11 all � Ir 2 � (� <br /> Authorized Agent and Title: <br /> Telephone Number: (�T-z ) X 20 <br /> B . Proposed Connection or Use : (check appropriate box or boxes) NON-REFUNDABLE <br /> ❑ Culvert connection to District canal for irrigation or drainage $ 100. 00 <br /> El Pump connection to District canal for irrigation or drainage $300.00 <br /> ❑ Culvert and/or control structure in District canal for crossing <br /> and/or water storage $200 . 00 <br /> Other (specify) <br /> C . Location : TractSectionTowdship , Range I Canal No. 1'u <br /> Other appropriate description : ADD 81 ivt C, D.;r <br /> Property I. D . Parcel No. : _ <br /> Attach drawing to show details (include acreage to be served) . <br /> D . Details of proposed Construction : (Give diameter and length of culvert ; diameter and rated capacity <br /> of pump ; height and width of riser or other details on water control structure. ) <br /> Rpl � � ra5 — 5u Cts° wl R � (' — <br /> E. Special Conditions: (for District use only) 2 i LJtaz tj� r , rr . 7Z " ID» C _ <br /> O2 1 ..kyP(ZA1- LlCL I.:QV7Vh �v! IA15i_, L1. l�Aj0 1 /ZF ' ?--y ;r0 / 3 <br /> J <br /> E A Sr 1 N V Z=n�T = 1 "L , 9 � /Ll ri V 0 - 4) <br /> E Estimated Date of Construction Commencement : 5 _ <br /> Estimated Date of Construction Completion : <br /> G. As the Applicant for permit, I do understand and agree that: <br /> 1 The use of, or construction within , the right-of-- way of the Indian River Farms Water Control District <br /> will be in accordance with the details of the approved sketch and/or permit conditions shown hereon, <br /> supporting this application; and if any changes are required, same will be cleared with the District. <br /> (Continued on Reverse hereof) <br /> p <br /> Signed: 4. ;4 'J Date e 1 <br /> Applic <br /> - - - - - - - - - - - - <br /> (For District Use Only) — <br /> Application approved by : <br /> for t r r Farms Water Control District <br /> Application approved by : <br /> i <br /> for C r Associates, Inc. , Engineer for District <br /> Date of approval : <br /> Expiration Date of this approved application : <br /> PERINIISSION , WHEN GRANTED , WILL BE SUBJECT TO THE STANDARD PROVISOS. <br /> SET FORTH ON THE REVERSE HEREOF. <br />