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1 I <br /> Cont'd from pg 2 . <br /> Application Evaluation Review Sheet <br /> Applicant Name : W. C . Graves III <br /> Address : P . O . Box 998 , Vero Beach , FI . 32961 <br /> Tract Number(s) : Begley <br /> Field Number(s) . <br /> Date . January 14 , 2003 <br /> VI : Revietimma <br /> Land Use/Field : Acres : <br /> Micro-Irrigated Citrus Grove 33 <br /> Best Management Practices Applied For: <br /> 2. Install 1 FBR H2o Control Structure. <br /> Total BMP Costs : 75% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost: <br /> $4 , 139 . $ 3 , 104 25 124 . 17 $ 1 , 036 <br /> VIL' 1�terri�irks�- <br /> (Signature) D : (Checked By) Date: <br /> IRSWCD Board Approval Date <br /> W, <br /> G / / - <br /> (Applicant Signature) 7 Date <br /> Privacy Act Statement: The following statements are made in accordance with the Privacy Act of 1974 (5U . S .C . 522a) . <br /> The authorities for requesting the information to be applied on this form are: 16 U .S .C . 590a-f (Soil and Water Conversation) ; <br /> 16U .S .C . 3801 et seq . (Food Security Acto of 1985 , as ammended) , and the regulation promulgated theruder. The information <br /> requested is necessary for the evaluation of an application , development and implementation of a conservation plan as the <br /> basis for satisfying program eligibility and compliance requirements , and for providing technical education , or financial assist- <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 furnished 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 />