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Authorized Agent and Title: _MV If, C r..l"J 1 !2 , 4? 1:—:., <br />Telephone Number: -r7 Z -7-7-LP — t ZZA <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 />❑ 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) _ .$4QG-.90- 14c,,,, <br />C, Location: Tract 1�1jp. ,Section �_, Township `� , Range ?�ar� , Canal No. C_ * G -Z <br />Other appropriate description: 74 -TU AVe-, 6.vJ, A40 l-tq- �Sr_ s -W. <br />Property I.D. Parcel No.: til& - Wit - t"a IZ449 7- cF w4a-1 <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 />VJ1TU t.9. IZ40n e-4-4 P, BENS"-,, V4P-0,04- WjW_ 9W— iD..j AL "94 Tb <br />TL V_ FlIP-. 44,06"o m ur-r'ua ,c.e+ . <br />E. Special Conditions: (for District use only) <br />�i l' WA4...AAC"O 4-i'57- 'n� 4- <br />F. <br />F Estimated Date of Construction Commencement: 2_/1ff>%1 a <br />Estimated Date of Construction Completion: �J: j1 ca I ram <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 />Signed: <br />(Continued on Reverse hereof) <br />Date 11/2, <br />PV1scant <br />---^— ----e—_ ,— —(For District Use Only) --o_ee--®®—®r--- <br />Application approved by: �Z�"?� ' <br />Application approved by: <br />Date of approval: <br />Expiration Date of this approved application: <br />`Inds n River Farms -Water Control District <br />for Carter Associates, Inc., Engineer for District <br />-'I_."sr <br />PERMISSION, WHEN GRANTED, WILL BE SUBJECT TO THE STANDARD PROVISOS. <br />SET FORTH ON THE REVERSE HEREOF. <br />