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INDIAN RIVER FARMS WATER CONTROL DISTRICT 7305 4th Street Vero Beach, Florida 32968 (772) 542-22141 APPLICATION FOR CONNECTION TO: OR USE OF DISTRICT FACILITIE Date: _I �36 2 a No.p A. Applicant Information: Name: Irlt7(pn1 P44ay- cct_J,.1T-1 6c Address: t e<,O �/fiPt? E��.l�t_I-1 i f"�-tf 3Zl1fcM:% Authorized Agent and Title: W, G+.►, i i a ==�i5 tt a r t u ti J~c < Telephone Number: `77Z.-2-Ze_0 - i 2.zi- %c'Y B. Proposed Connection or Use: (check appropriate box or boxes) NON-REFUNDABLE ❑ Culvert connection to District canal for irrigation or drainage $100.00 ❑ Pump connection to District canal for irrigation or drainage $300.00 Culvert and/or control structure in District canal for crossing and/or water storage $200.00 ❑ Other (specify) $100.00 C. Location: Tract. t-4/4 Section t 2 , Township 33.E Range �, Canal No. - P-4 Other appropriate description: t _4Yr, , rx3t7 43r7.;A m� . Property I.D. Parcel No.: t4 /A i izL zo z. - Attach drawing to show details (include acreage to be served). D. Details of proposed Construction: (Give diameter and length of culvert; diameter and rated capacity of pump; height and width of riser or other details on water control structure.) Le— '4:t�= --`"irl;- iii i�< . _1+1 t. .ice- .fG car !<:1:_F=\' .-Y�11T E. Special Conditions: (for District use only) F &-Ir ii 7F4 4'1-1 05-, 4Dr i f //fL Ct�jt! t� T a t�cz9 j F. Estimated Date of Construction Commencement: MAY ZOZA Estimated Date of Construction Completion: Auc uS 1 207_1 G. As the Applicant for permit, I do understand and agree that: 1. The use of, or construction within, the right-of-way of the Indian River Farms Water Control District will be in accordance with the details of the approved sketch and/or permit conditions shown hereon, supporting this application; and if any changes are required, same will be cleared with the District. (Continued on Reverse hereof) Signed: Date A)y Zf)20 Ap 1' t ----------------------------------------- A (For District Use Only) Application approved by: Application approved by: Date of approval: Expiration Date of this approved application: /- 7.2- Z-7- PERMISSION, 'L PERMISSION, WHEN GRANTED, WILL BE SUBJECT TO THE STANDARD PROVISOS. SET FORTH ON THE REVERSE HEREOF.