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Facility Website` <br />Facility Email Address: <br />Mailing Address(if different): <br />City44" , <br />Facility's Fiscal Year from tiD <br />Contact Responsible for CVA Grant Application and Project Implementation Information <br />Name: <br />Address: <br />Name: <br />Address: <br />w <br />6"' <br />Is the facility owned/operated by a self-insured governmental entity (state, county or city)? OYes O No <br />Marina Boating Facility Information <br />Type of Facility (check all that apply): ❑ Marina ❑ Boatyard ❑ Yacht/Boat Club ❑ Pumpout Business <br />❑ Dockominium Boat Ramp ❑ Mooring Fields <br />Is the facility involved in any community O Yes O No If yes, please describe: " 9' <br />partnerships or public events? <br />Name of the commonilocal waterbody where the facility is located: <br />Salinity of thecommon/local waterbody 0 Saltwater O Freshwater 0 Brackish <br />Facility Coordinates (in decimal degrees)? Latitude: }' Longitude: <br />Find your facility's coordinates here: itouchmap.com/latlong.html <br />Is the Facility: <br />❑ Existing Marina Facility ❑ Facility currentlyunder construction ❑ Proposed Marina Facility (not under construction) <br />163 <br />Clean Vessel Act Grant Application Form <br />Facility General Information <br />Federal Employer ID #. <br />Facility Name s � :. F <br />. <br />Facility Address <br />City.` °`� .... , <br />„. k . State: ZIP Code: Canty.: <br />Phone Number: <br />Fax_mmber: <br />Facility Website` <br />Facility Email Address: <br />Mailing Address(if different): <br />City44" , <br />Facility's Fiscal Year from tiD <br />Contact Responsible for CVA Grant Application and Project Implementation Information <br />Name: <br />Address: <br />Name: <br />Address: <br />w <br />6"' <br />Is the facility owned/operated by a self-insured governmental entity (state, county or city)? OYes O No <br />Marina Boating Facility Information <br />Type of Facility (check all that apply): ❑ Marina ❑ Boatyard ❑ Yacht/Boat Club ❑ Pumpout Business <br />❑ Dockominium Boat Ramp ❑ Mooring Fields <br />Is the facility involved in any community O Yes O No If yes, please describe: " 9' <br />partnerships or public events? <br />Name of the commonilocal waterbody where the facility is located: <br />Salinity of thecommon/local waterbody 0 Saltwater O Freshwater 0 Brackish <br />Facility Coordinates (in decimal degrees)? Latitude: }' Longitude: <br />Find your facility's coordinates here: itouchmap.com/latlong.html <br />Is the Facility: <br />❑ Existing Marina Facility ❑ Facility currentlyunder construction ❑ Proposed Marina Facility (not under construction) <br />163 <br />