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INDIAN RIVER FARMS WATER CONTROL DISTRICT r 4400 20th Street Vero Beach, Florida 32960 (561) 562-2141 rr APPLICATION FOR CONNECTION TO OR USE OF DISTRICT FACILITIES Date : 10 / 12 / 04 No . A. Applicant Information: Name: Indian River County Engineering Division Address : 1840 25th street dw Vero Beach , F ?, 32960 Authorized Agent and Title : Michelle A . Gentile , CET Civil Engineer f Telephone Number: ( 772 ) 567 - 8000 ext . 1280 Be Proposed Connection or Use : (check appropriate box or boxes) NON-REFUNDABLE AN ❑ Culvert connection to District canal for irrigation or drainage $ 100.00 ❑ Pump connection to District canal for irrigation or drainage $300 . 00 ❑ Culvert and/or control structure in District canal for crossing r and/or water storage $200. 00 ® Other (specify) Culvert portions of the Sub - Lat A - 6 $ 100. 00 canal aw C. Location : Tract Section 2 7 , 2 8 , 2,5rownship 3 2 Range 39 Canal No . su b -- L a t A6 Other appropriate description: South side 41st between 58 th Ct . to 49th Ave , Property I.D. Parcel No. : & 43rd Ave & 41st err Attach drawing to show details (include acreage to be served) . D. Details of proposedConstruction : (Give diameter and length of culvert; diameter and rated capacity of pump ; height and width of riser or other details on water control structure.) Remove existing culverts in areas depicted on the plans along S . side 41st . in the sub - lateral A - 6 canal. . install- 4340 LF of 48 " x 76 " RCP in the sub - lateral. A - 6 canal. Install 706 LF 18 " perforated BCCMP & 283 LF 24 " Perferated BCCMP adiacent . to 48 " x 76 " RCP E. Special Conditions: , (for District use only) 4W weir A '1" r4c- fIED L i 5 �" U �= ��'�'�'!/� [: CJ•v !�/T7D.� F. Estimated Date of Construction Commencement: March 2005 Estimated Date of Construction Completion : G. As the Applicant for permit, I do understand and agree that : err 1 . The use of, or construction within, the right-of-way of the Indian River Fauns Water Control District will be in accordance with the details of the approved sketch and/or permit conditions shown hereon, supporting this application ; and if any changes are required, same will be cleared with the District. rr (Continued on Reverse hereof) Signed: O ��i Date r Ap icant — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — y �or Distri t Use Only) r Application approved by: - r td12 f the Indian River ms Water Control District y yr Application approved by: for Carter Associates, Inc . , Engineer for District Date of approval: Sr 191A6 Expiration Date of this approved application : PERMISSION, WHEN GRANTED, WILL BE SUBJECT TO THE STANDARD PROVISOS „�, SET FORTH ON THE REVERSE HEREOF.