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APPNUM 06 <br /> SJRWMD office use <br /> ST. JOHNS RIVER WATER MANAGEMENT DISTRICT ! <br /> STORMWATER MANAGEMENT PROJECTS COST-SHARING PROGRAM <br /> APPLICATION FORM <br /> Fiscal Year 2005-2006 <br /> Submission deadline. Applications must be received by the St. Johns River Water Management <br /> District (SJRWMD) or dated by the U. S . Postal Service or a commercial carrier no later than Friday, <br /> August 12, 2005 . Submit three copies of this form and all supporting materials to Denis W. Frazel, c/o <br /> David Watt, St. Johns River Water Management District, 4049 Reid Street, Palatka, FL 32177 . For <br /> application assistance, contact Denis Frazel at (386) 329-4616 or dfrazel@sjr-wmd. com . Applications <br /> that are substantially incomplete or are not completed according to instructions will be <br /> disqualified. Excess materials will not be considered. Read and follow instructions . Selected <br /> evaluation criteria accompany questions pertaimng to them in the application. Complete evaluation <br /> criteria are provided in the separate instruction document. <br /> Type or print clearly the requested information in the spaces provided. <br /> Title of project ROAD PAVING PROJECTS ALONG THE INDIAN RIVER LAGOON <br /> A. APPLICANT INFORMATION <br /> A- 1 . Name of applicant INDIAN RIVER COUNTY <br /> (may be utility, local government, agency, company, individual, or other) <br /> A-2 . Name, address, e-mail address, and phone/fax numbers of project manager or contact <br /> person. SJRWMD will sena correspondence concerning this application ONLY to this person. <br /> Name Keith McCully, P . E . <br /> E-mail address kmccully@,ircgov. com <br /> Mailing address 1840 25th Street <br /> City and zip code Vero Beach, FL 32960 <br /> Phone (772) 567- 8000, ext. 1562 Fax (772) 778 - 9391 <br /> A-3 . Name, address, and phone/fax numbers of person with authority to enter into a contractual <br /> agreement, if other than project manager or contact person. If same as 2 above, check box . ❑ <br /> Name Thomas S . Lowther, Chairman, Indian River County Commission <br /> Email address <br /> Mailing address 1840 25th Street <br /> City and zip code Vero Beach, FL 32960 <br /> Phone 772) 567 - 8000, ext . 1490 Fax (772) 770- 5334 <br /> A-1 <br />