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/ _ <br />APPNUM 01 <br />SIRW MD office Use <br />ST. JOHNS RIVER WATER MANAGEMENT DISTRICT <br />ALTERNATIVE WATER SUPPLY CONSTRUCTION COST SHARING <br />APPLICATION FORM <br />FY 2000-2001 <br />Submission deadline: Applications must be received by SIRWMD 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 Stan Browning, St. Johns River Water Management District, P,O. Box 1429, Palatka, FL, 32178- <br />1429 if sent by U.S, mail. Appl'icat'ions sent by courier should be addressed to 4049 Reid Street, Palatka, FL, <br />32178-1429. For application assistance contact Stmt Browning at 904-3294321 or star brotitininglar <br />district -sjnvmzd. state. fl.us. You may, add up to one additional page of supporting material for any answer tltat <br />needs further explanation. Applications which are substantially incomplete or not completed according to <br />instructions will he disqualified. Excess materials will not be considered. Read and follow instructions! <br />Type or print clearly the requested information in the spaces provided. <br />A, Applicant Information <br />1. Name of Applicant: Indian Riv r Coun%Utihtiq-s- DeMnent <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 1940 25"' Street <br />_ <br />City and zip code Vero Beach FL 32960 <br />Phone (561) 567-8009, ext. 1821 <br />FAX (561) 770-5143 <br />(include arc code) <br />(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 />%lame - Fran_B. Adams. Chain nmt, IndianRiverCounty Board ofCounty _Commissioners <br />Mailing address 1840 25" Street <br />_. <br />City and zip code Vero Beach, FL 32460 <br />Phone (561) 567.8000, oxt. 1830 <br />FAX (561) 770-5143 <br />(include area code) <br />(include area code) <br />Page A - <br />rM1IbR19]IRMk'r'LL. vrll�t-1]r[iL1.VUYfi H�M1wa•1.ifh lLu�n vw�w.i.4➢ �Rnw gown Al..nb;. W—. .14r1 1.0,Ap/b�,.1AAIM U"—W. <br />PS.skx <br />