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e <br /> J <br /> Cont'd from pg 2 . t I <br /> bA 3 � <br /> Application Evaluation Review Sheet <br /> Applicant Name : Applicant #414 A; Hammond Groves , Ilice <br /> Address : P . O . Box 3278 , Vero Beach , FL 32964 <br /> Tract Number(s) : Heritage Block, Reservoir west . <br /> Field Number(s) : <br /> Date : July 9 , 2004 <br /> 77 <br /> Land Use/Field : Acres : <br /> Micro-Imgated Citrus Grove 80 <br /> Best Management Practices Applied For: <br /> Install 1 FBR H2o Control Structure. <br /> Total BMP Costs: 75% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost: <br /> y`t { $7 , 971 $5 , 978 25 239 . 13 $ 1993 <br /> �liiv' C�1 ■ 36� 4 Jjjjr <br /> (Signature) Dat : (Checked By) D e: <br /> r <br /> c . 1 <br /> cj�cl? rd Approval Dpte <br /> logo <br /> z3 � <br /> (Applicant Signature) Date <br /> Privacy Act Statement: The following statements are made in accordance with the Privacy Act of 1974 (5U . S .C . 5 ). <br /> The authorities for requesting the information to be applied on this form are: 16 U . S . C . 590a-f (Soil and Water Conve ion) ; <br /> 16U .S.C. 3801 et seq. (Food Security Acto of 1985, as ammended) , and the regulation promulgated theruder. The infaTnation <br /> requested is necessary for the evaluation of an application, development and implementation of a conservation plan as he <br /> basis for satisfying program eligibility and compliance requirements, and for providing technical education, or financial ssist- <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�theDther <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 />