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Pag <br />INDIAN RIVER FARMS WATER CONTROL DISTRICT I 11-e 1 <br />7305 4th Street %�', 3 0 20t7 <br />Vero Beach, Florida 32968 <br />(772) 562.2141NC�o-oV RIVER COUNTY <br />G DIVISION <br />APPLICATION FOR CONNECTION TO.OR USE OF DISTRICT FACILITIES <br />Date: 1 /2 4/ f 7 <br />No. 17'-31 <br />A. - Applicant Information: Name: / A/0 t A N PItE COW...) Tt! <br />Address:. 1119 I 2.7m. <br />5? <br />VFQe) (3Ea4.0 , t i_ . 32'160 <br />Authorized Agent and Title: W t LII AHI 'SO NNS OtU j PE <br />Telephone Number: 7 72 -22(.--!(C <br />B. Proposed Connection or Use: (check appropriate box or boxes) NON-REFUNDABLE <br />O Culvert connection to District canal for irrigation or:drainage $100.00 <br />O Pump connection to District canal for irrigation or drainage $300.00 <br />O, Culvert and/or control structure in District canal for grossing <br />and/or water storage $200.00 <br />GI/Other (specify) (Ai,1;Ns"Dt- -, $100.00 <br />49 sr, <br />C. Location: Tract , Section 20 -ZZ- Township 3 2 S . Range 11E. . Canal No. 500 -f A'1 <br />Other appropriate description: <br />Property LD. 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 stricture.) <br />Lt. t'.; PCS (./2FA OF yQ' STREET rgoevi STr"Avt:n.ty( fa 31AurPuE <br />Cc TUG-rtoN Of A(,prf'OI-)AL Cvit 3 A4-1.tn CU -ME R,f1s-o'VC d Ooterta►v GE T+rE <br />Sou -n-1 gdgs OF T++E P,Ro1CCT <br />E. Special Conditions: (for District use only) <br />Se -Er 4-rrA L 1 Qt- SPECIA L Cb vr. tr/zmis <br />R Estimated Date of Construction Commencement:.. /O/Zo /9 <br />Estimated Date of Construction Completion: «/z , i9• <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 pn :Reverse hereof) <br />Signed: <br />ant <br />Application approved by: <br />Application approved by: <br />Date /7-f6,4,3 / <br />(For District Use Only) <br />Date of approval: / /— / 7-1'7 <br />Expiration Date of this approved application: s - / 7 / 9 <br />PERMISSION, WHEN GRANTED, WILL BE SUBJECT TO THE STANDARD PROVISOS. <br />SET FORTH ON THE REVERSE HEREOF. <br />Carter Associates, Ino., Engineer for District <br />