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4D <br />[-I <br />ab <br />_�-_ _11-ev <br />525010-300 Anust 20,1997 <br />N Loml Agency P!72rrsin Masnal Chapter 2 Stetion I <br />PROJECT FUNDING APPLICATION CHECKLIST <br />LOCAL AGENCY- I ndi an Biver CQUOLY PROJECT IDENTIFICATION: 230897-1-52-01 <br />WORK PROGRAM ITEM NO.: STIP PAGE NO. <br />TIP PAGE NO.: <br />Use this sheet as a cover sheet to the project application package. Place an"X"in the tight column to <br />denote items included. If not applicable. state N/A, include in the cover letter a comment explaining the <br />action taken on each item as appropriate, <br />Application: <br />I <br />Federal aid Project Fundiniz Request (Chap, 1]-1) ... .................... <br />X <br />2, <br />vicinin Map ........... _ ......................... <br />3. <br />Typical Roadway Section .......... ............... ......... <br />X <br />4. <br />'!" ,pica] Bridge Section ................. ........................... <br />N/A <br />5a. <br />Local Agircement (Chapter 11-2) .. . ....................... ........... <br />X <br />5b, <br />Resolution No, -, Dated: <br />(if required) ........... ...... ................................... <br />X <br />Supporting Data; <br />6. <br />State Clearinghouse ([CAR) (Chapter 14) . . . . ........ ............ <br />N/A <br />7. <br />Safery Improvements --- <br />(Chapter <br />(Chapter IV-)). , _ . .............. ............ ........ ..........N/A <br />& <br />Photos of Railroad Crossing . . .... ......... ...... .......... <br />NIA <br />9. <br />Deviation Request and Juslification(Chapter IV- I ...... ........... _.. <br />10, <br />Environmental Document (Chapter 11.4) .............................. <br />it, <br />Compliance with environmental document commitments .......... <br />12. <br />Right of Way Required (Chapter 11-5) . , . .... ...... _ ............ <br />il. Pre -Qualification Letter of Approval <br />FromFDOT ... _ ........ __ ............................. <br />N/A_ <br />b. Right -of -Way Maps ......................................... <br />NL&_ <br />C. Right of Way Project Cost Estimate ... ­­ ..... ............... <br />N/A <br />d- Request Right of Way Project Authorization.. ................. <br />N/A <br />13. <br />Right Of Wav Certification (Chap.11-Sect 5). . .. . . ..... ................. <br />N7A_ <br />14, <br />Agreements/Easements with Railroads. Utilities. <br />and Other Agent; i es (FDO'rs Project Development <br />and r'zj 2; Grade <br />Crossing, Procedure No. 725-080- 120, and <br />Utility Negotiation/Agreements, Procedure <br />No. 710-010-050) ........................................... <br />N/A <br />is. <br />Corp of Engineers, and/ur Coast Guard Permits (Environmental Permit Coordination <br />Procedure No, 650-040-001) ......... ........ ............... <br />16. <br />Water Management District Permit <br />N/A <br />7, <br />14PUES Permit <br />N/A <br />18. <br />FAA Notification (FAA for 7460.11 N 4 CFR_, <br />NiA <br />Exhibit 11 -la - Project I'LlMing �Applimon Checklist <br />2-1-2 <br />