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i � r %e / /3 Cont'd from pg 2 . Application Evaluation Review Sheet Applicant Name : jApp . #49 , S . R . Burch and Sons Address : 1905 West Story Rd . Winter Garden , FI . 34787 Tract Number(s) : Field Number(s) : 1 -Jan Date : INov . 16 , 2002 V1 .Review Summary: Land Use/Field : Acres : Micro-Irrigated Citrus Grove 173 Best Management Practices Applied For: 2. Install 2 FBR H2o Control Structures. Total BM P Costs : 75% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost: $7 , 993 $5 , 995 50 119 . 90 $ 1 , 998 . VIL Remarks : VIJI. Designated Conservationist: (Sign ure e: 7 (Checked By) Date: .3 -a 03 IRSWCD Board proval Date /- / - d (Applicant Signature) Date Privacy Act Statement: The following statements are made in accordance with the Privacy Act of 1974 (5U .S .C . 522a) . The authorities for requesting the information to be applied on this form are: 16 U .S .C . 590a-f (Soil and Water Conversation) ; 16U .S .C . 3801 et seq . (Food Security Acto of 1985 , as ammended) , and the regulation promulgated theruder. The information requested is necessary for the evaluation of an application , development and implementation of a conservation plan as the basis for satisfying program eligibility and compliance requirements , and for providing technical education , or financial assist- ance under the previously mentioned authorities. Furnishing this information is voluntary; however, failure to furnish correct, complete information will result in the withholding or withdrawal of such technical, educational, or financial assistance. This information may be furnished to other USDA agencies, the Internal Revenue Service, the Department of Justice, or the other State or Federal law enforcement agencies , or in response to orders of a court, magistrate, or administrative tribunal. IRSWCD Page 3 ( 10-26-01 )