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SJRWMD Alternative Water Supply Construction Cost -Sharing Application Form 2003-2004 <br /> Y <br /> Phone (772) 567-8000, ext . 1490 Fax (772) 770- <br /> 5334 <br /> 4. SJRWMD permit information <br /> Does the applicant have any SJRWMD permits? Yes ® No ❑ <br /> Myes, list all SJRWMD consumptive use permits held by the applicant AND any surface water <br /> management or environmental resource permits pertaining to the project . Attach an additional page <br /> behind this page if needed. <br /> Permit # Exyiration Date (mm/dd/yy) Permit # Expiration Date (mm/dd/ <br /> 10524 12-31 -2020 <br /> 5. Other permit information. List all types of permits required to construct the proposed project and <br /> provide the status of efforts to obtain each permit. <br /> Type of Permit Issuing Agency Have Permit Applied Not Applied <br /> Utift Construction F.D .E.P. ® ❑ ❑ <br /> Mixing Zone F.D .E.P . ® ❑ ❑ <br /> Ut&Y Construction MYWCD ® ❑ ❑ <br /> Right of Way Indian River County ® ❑ ❑ <br /> Utility Construction Indian River County Utilities ® ❑ ❑ <br /> 6. Disclosure. Does any SJRWNID employee, Governing Board member, contractor, or other affiliate <br /> of the applicant have a financial interest in this project, the property associated with this project, or with <br /> any party that may profit financially from this project? Yes ❑ No <br /> If , yes, identify all such parties and describe their interests . <br /> A-2 <br />