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A � <br /> Cont'd from pg 2 . )r/-// %3i <br /> Application Evaluation Review Sheet <br /> Applicant Name : Appl . #4 : Citrus from Indian River <br /> Address : P . O . Box 1266 Vero Beach , FI . 32961 <br /> Tract Number(s) : <br /> Field Number(s) : 1 <br /> Date : Nov. —16 , 2002 <br /> vl . er+•iw Bumrrta = � . <br /> Land Use/Field : Acres : <br /> Micro-Irrigated Citrus Grove <br /> Best Management Practices Applied For: <br /> Installation of Chemigation Infrastructure. <br /> Total BMP Costs: 70% Cost Share: Div By Total Eval Points : = Applicant's Score: Applicant Cost, <br /> $ 1 , 283 . $898 20 44 . 92 $385 . <br /> erlriats: <br /> Vlli esionatOTCd . rvationist: ' .: . 1A I <br /> n . <br /> 01 <br /> (Signature) De: do <br /> (Checked By) Date: <br /> —/-7/ ,3o <br /> 1 SWCD Board Approval Date <br /> 1J <br /> (Applicant Signature) ate <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 fumished 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 />