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SJRWMD Alternative Water Supply Construction Cost-Sharing Application Form 2004-2005 <br /> 4. SJRWMD permit information <br /> Does the applicant have any SJRWMD permits? Yes ® No ❑ <br /> If yes, list all SJRWMD consumptive use permits held by the applicant AND any surface water <br /> management or environmental resource permits pertaining to the project. Attach an additional page <br /> behind this page if needed. <br /> Permit # Expiration Date Permit # Expiration Date <br /> (mm / dd / yy) mm ddZyy <br /> 10524 12-31-2020 <br /> 5. Other permit information. List all types of permits required to construct the propoc ed project and <br /> provide the status of efforts to obtain each permit. <br /> Type of Issuing Agency Have Applied Not <br /> Permit Permit Mplied <br /> Utility Construction F. D.E.P. ❑ ❑ <br /> Right of Way Indian River County ❑ ❑ <br /> Utility Construction Indian River County Utilities ❑ ❑ <br /> Utih!y Construction Indian River Farms WCD ❑ ❑ <br /> 6. Disclosure. Does any SJRWMD employee, Governing Board member, contractor, or other affiliate <br /> of the applicant have a financial interest in this project, the property associated with this project, or <br /> with any party that may profit financially from this project? Yes ❑ No <br /> If yes, identify all such parties and describe their interests. <br /> B . Project Information <br /> 1 . Cost-sharing request (SJRWMD' s share cannot exceed 50 % of total project cost) <br /> a. Total project cost. . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . <br />. . . . . . . . . . . . . . .. . . . . $ 2 737 75 . <br /> b. Amount of cost-share requested . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . <br />$250 000.00 <br /> A-2 <br />