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Cont'd from pg 2 . ` <br /> blt ' 3 <br /> Application Evaluation Review Sheet <br /> Applicant Name : Applicant #404 Schacht Groves <br /> Address : 610012 St. Vero Beach , FL 32966 <br /> Tract Number(s) . <br /> Field Number(s) : 11 <br /> Date : July 9 , 2004 <br /> A <br /> Land Use/Field : Acres . <br /> Micro-Irrigated Citrus Grove 10 <br /> Best Management Practices Applied For: <br /> 2. Install 1 FBR H2o Control Structure. <br /> Total BMP Costs: 75% Cost Share, Div By Total Eva[ Points: = Applicant's Score: Applicant Cost: <br /> $67653 . 00 $4 , 990 25 199 .59 $ 1 ,663 <br /> OamiA� Igio <br /> 1'071fla4eoe <br /> 7 i <br /> (Signature Date: (Checked By) Dat <br /> LL71 <br /> — 3 <br /> RSWCD Board Approval Date <br /> C <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 Conver. ation) ; <br /> 16U .S .C . 3801 et seq. (Food Security Acto of 1985, as ammended) , and the regulation promulgated theruder. The info ion <br /> requested is necessary for the evaluation of an appNcation, 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 assist- <br /> ance <br /> ssistance under the previously mentioned authorities. Furnishing this information is voluntary; however, <br /> failure to furnish corect, <br /> complete information will result in the withholding or withdrawal of such technical, educational, or financial assistance. rhis <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 />