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Cont'd from pg 2 . r ' CXh � 6 0 r 7B Application Evaluation Review Sheet Applicant Name : App . #325 , Belair Groves , Joint Venture , Gracewood Inc. Address : P . O . Box 370 , Vero Beach , FL 32961 Tract Number(s) : 1 Field Number(s ) : 43-44 , 63-649 54 Date : Nov . 6 , 2003 VI . Review Summary * Land Use/Field : Acres : Micro-Irrigated Citrus Grove 489 Best Management Practices Applied For: 2. Install 3 FBR H2o Control Structure. Total BMP Costs : 75% Cost Share: Div By Total Eval Points : = Applicant's Score: Applicant Cost: $ 16 , 044 . 00 $ 127033 75 160 . 44 $4 , 011 . 00 VII. Remarks: V111. Designatecl COnOrvationist, (Signature) Date (Checlked By) Date: If WCD BoarjW Approval Date 03 (Applicant Signature) Date Priv cy Act Statement: The following statements are made in accordance with the Privacy Act of 1974 (5U .S .C . 522a) . The authorities for requesting the information to be applied on this form are: 16 U .S.C . 590a-f (Soil and Water Conversation) ; 16U .S .C . 3801 et seq . (Food Security Acto of 1985 , as ammended) , and the regulation promulgated theruder. The information requested is necessary for the evaluation of an application , development and implementation of a conservation plan as the basis for satisfying program eligibility and compliance requirements, and for providing technical education , or financial assist- ance under the previously mentioned authorities. Furnishing this information is voluntary; however, failure to furnish correct, complete information will result in the withholding or withdrawal of such technical, educational , or financial assistance. This information may be furnished to other USDA agencies, the Internal Revenue Service, the Department of Justice, or the other State or Federal law enforcement agencies , or in response to orders of a court, magistrate, or administrative tribunal . IRSWCD Page 3 ( 10-26-01 )