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• <br />Cont'd from pg 2. <br />� r <br />,EXE/3/T <br />Application Evaluation Review Sheet <br />Applicant Name: <br />Appl. <br /># 45, Robert Adair <br />Address: <br />7060 33 Street, Vero Beach, FI. 32966 <br />Tract Number(s): <br />Field Number(s): <br />1 -Jan <br />Date: <br />Nov. 16, 2002 <br />VL to I'm umrlrtary: .. <br />Land Use/Field: <br />Acres: <br />Micro -Irrigated Citrus Grove <br />4 <br />Best Management Practices Applied For: <br />8. Water Table Observation Well <br />Total BMP Costs: <br />5% Cost Share: Div By Total Eval Points: <br />= Applicant's Score: <br />Applicant Cost: <br />�y <br />$37 <br />$28 <br />�- 5 <br />5.62 <br />$9 <br />/� <br />V11 :itnfrrarlrs• <br />V111. <br />Desj9n�ltdl:l` <br />tYtt <br />dtit)rllj <br />S/m?� <br />// 25.-402.---- <br />lag <br />ZJr/OC.-� <br />D e: <br />(Checked By) <br />Date: <br />4Signature) <br />/1 <br />Board Appro <br />c.,/.. <br />/-13-O <br />Date <br />-- <br />-I <br />'SWCD <br />(Applicant <br />Signature) <br />Date <br />Privacy Act Statement: The following statements are made <br />in accordance with the Privacy Act of 1974 (5U.S.C. 522a). <br />The authorities for requesting <br />the information to be applied <br />on this form are: 16 U.S.C. 590a -f (Soil and Water Conversation); <br />16U.S.C. 3801 et seq. <br />(Food Secunty <br />Acto of 1985, as ammended), and the regulation promulgated theruder. The information <br />requested <br />is necessary <br />for the evaluation of an application, <br />development <br />and implementation <br />of a conservation <br />plan as the <br />basis for satisfying <br />program eligibility and compliance <br />requirements, <br />and for <br />providing technical education, or financial assist- <br />ance under the <br />previously mentioned authorities Furnishing this information <br />is voluntary; however, failure to furnish correct, <br />complete <br />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 <br />the Internal Revenue Service, the Department <br />of Justice, or the other <br />State or Federal law enforcement agencies, <br />or in <br />response <br />to orders of a court, magistrate, or administrative tribunal. <br />Page 3 <br />IRSWCD <br />(10-26-01) <br />