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1 <br /> Xi'fi�3 iT � f <br /> Cont'd from pg 2. <br /> Application Evaluation Review Sheet <br /> Applicant Name: App. M, Brian Quant <br /> Address: 17195 37 St.Vero Beach, FI. 32966 <br /> Tract Number(s): <br /> Field Number(s): <br /> Date: INov. 16, 2002 <br /> Vl.,Reviewsummarr <br /> Land Use/Field: Acres: <br /> Micro-Irrigated Citrus Grove 40 <br /> Best Management Practices Applied For: <br /> 2. Install 6 FBR 1­12o Control Structures. <br /> Total BMP Costs: 75%Cost Share: Div By Total Eval Points: =Applicant's Score: Applicant Cost: <br /> $10,000. $7,500 150 50.00 $2,500. <br /> 1/11. It�rrrarks: <br /> VIII. Elpsignat6ti Ctinservatiortist: <br /> 6Z S�� AX5 <br /> (Signature) Date: hecked By) Date: <br /> zlb?eL2. 4wlllz-t� l/.3_2�3 <br /> IRSWCD Board Approval Date 77 <br /> (Applicant Signature) Date <br /> Privacy Act Statement: The following statements are made in accordance with the Privacy Act of 1974(5U.S.C.522a). <br /> The authorities for requesting the information to be applied on this form are: 16 U.S.C.590a-f(Soil and Water Conversation); <br /> 16U.S.C.3801 et seq.(Food Security Acto of 1985,as ammended),and the regulation promulgated theruder.The information <br /> requested is necessary for the evaluation of an application,development and implementation of a conservation plan as the <br /> basis for satisfying program eligibility and compliance requirements,and for providing technical education,or financial assist- <br /> ance under the previously mentioned authorities. Furnishing this information is voluntary;however,failure to furnish correct, <br /> complete information will result in the withholding or withdrawal of such technical,educational,or financial assistance. This <br /> information may be furnished to other USDA agencies,the Internal Revenue Service,the Department of Justice,or the other <br /> State or Federal law enforcement agencies,or in response to orders of a court,magistrate,or administrative tribunal. <br /> IRSWCD <br /> Page 3 (10-26-01) <br />