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r f Cont'd from pg 2 . Application Evaluation Review Sheet Applicant Name : jApp. #29 Hammond Groves Address : 13885 41st Street , Vero Beach , FI . 32967 Tract Number(s) : Field Number(s) : Date : INov. 18 , 2002 WIReview'Summa . Land Use/Field : Acres . Micro-Irrigated Citrus Grove 360 Best Management Practices Applied For: 2. Install 9 FBR H2o Control Structures. Total BMP Costs: 75% Cost Share: Div By Total Eval Points: = Applicant's Score: Applicant Cost: $36 , 793 . $27, 595 225 122 . 64 $ 9 , 198 . v11: terk�: , v. Vill Desi ntl Ct�t�seratibnist » / o Z Lill ta7/ (Signature) Date: (Checked By) Date: IRSWCD Board Approval Date jA a� $ o3 (Applicant Signature) Date Privacy 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 )