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+ �,� 1: a_ APPNUM 01 <br />SJRWMD office use <br />e9v- 34 <br />ST. JOHNS RIVER WAFER MANAGEMENT DISTRICT <br />ALTERNATIVE WATER SUPPLY CONSTRUCTION COST SHARING <br />APPLICATION FORM <br />FY 2000-2001 <br />Submission deadline: Applications must be received by SJRWMD or dated by the US Postal Service or a <br />commercial carrier no later than Friday, December 8, 2000. Submit 3 copies of this form and all supporting <br />materials to St<'u] Browning, St. Johns River Water Mamagement District, P.O. Box 1429, Palatka, FL, 32178- <br />1429 if sent by U.S. mail. Applications sent by courier should be addressed to 4049 Rcid Street, Palatka, FL, <br />32178-1429. For application assistance contact Stan Browning at 904-3294321 or stan_browning rJ <br />district. sjnvmd.statc.fl.us. You may add up to one additional page. of supporting material for any answer that <br />needs further explanation. Applications which are substantially incomplete or not completed according to <br />instructions will be disqualified. Excess materials will not be considered. Read and follow instructions! <br />Type or print clearly the requested information in the spaces providers. <br />A. Applicant Information <br />1. Name of Applicant: Indian River Count3JJtilitics Deparunent <br />(May be utility, local govcmment, agency, company, individual, or other.) <br />2. Name, address, and phone numbers of project manager or contact person. <br />SJRWMD will sent correspondence concerning this application ONLY to this person. <br />Name Michael C. Hotchkiss P.E. <br />Mailing address 1840 25`F' Street <br />City and zip code Vero Beach, FL 32960 <br />Phone (561) 567-8000, ext. 1821 _ FAX 061),770-5143 <br />(include are code) (include area code) <br />3. Name, address, and phone numbers of person with authority to enter into a contractual agreement, <br />if other than project manager or contact person. <br />Name Fran B. Adams, Chairman, Indian Rivcr County_Board of County Commissioners <br />Mailing address 1840 250' Street <br />City and zip code Vera (teach FL 32960 <br />Phone (561)_567-8000, ext. 1830 FAX (,561) 770-5143 <br />(include arca code) (include arca code) <br />Page A - 1 <br />rPkSKRL'F7t,1Tik"t�d�IIf�.7 GII Y-SYa]lkrltL'LY lrakw VWA C--' Ik P—U 9shw Nos VI"- Aha *Wl S'41,r!0— 5Ly 59 1A, A1au..rriv 3,0l AkA�D@ '4w Nle <br />kw'Iw.wi Kyr ►'*� <br />