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INDIAN RIVER FARMS WATER CONTROL DISTRICT <br />4400 20th Street <br />Vero Beach, Florida 32960 <br />(772) 562-2141 <br />APPLICATION FOR CONNECTION TO OR USE OF DISTRICT FACILITIES <br />Date: l III t 7Or <br />A. Applicant Information: Name: <br />Addres <br />No. 0 Jr � CR <br />Authorized Agent and Title: An4o6rq LWF rn r Di rc.Gkor n- Land U=ek , ,n n�' <br />Telephone Number: (9 S 4) 7 5 3 1 jd <br />B. Proposed .Connection or Use: (check appropriate box or boxes) NON-REFUNDABLE <br />4 Culvert connection to District canal for irrigation ordry $100.00 <br />❑ Pump connection to District canal for irrigation or drainage $300.00 <br />❑ Culvert and/or control structure in District canal for crossing <br />and/or water storage $200.00 <br />❑ Other (specify) $100.00 r - -- <br />r2,tcr3�4' 57, 02,,ts i <br />Co Location: Tract Section 3S Township -33 , Range 39 _, Canal No. 6-1® <br />Other appropriate description: s, new AA.444. <br />Property I.D. Parcel No.: - 60001 - eeuo- a 00o i v - ooroo - 0000i p� <br />Attach drawing to show details (include acreage to be served). 600 01, � 1.OizUO4 40a 00 o, oiao � ,, <br />flans Akkaehed: %ILt ltxt! i Rf�GB /i5 BII leliv a'irr,,yr. c,u.s,` k•'Oudnu .t'.m� 1 -r 1 -ds <br />D. Details of proposed Construction: (Give diameter and length of culvert; diameter and rated capacity <br />of pump; height and width of riser or other details on water control structure.) <br />'Za2LF 30eAtG' Pipe 0DiSC.t\ar5& -!�rom conk-ro\ 5}rvckur2 (3 SN\i 14,9c) <br />E. Special Conditions: (for District use only) <br />F. Estimated Date of Construction Commencement: a� oS <br />Estimated Date of Construction Completion': (1 e 06 <br />G. As the Applicant for permit, I do understand and agree that: <br />1. The use of, or construction within, the right-of-way of the Indian River Farms Water Control District <br />will be in accordance with the details of the approved sketch and/or permitconditions shown hereon, <br />supporting this application; and if any changes are required, same will be cleared with the District. <br />(Cotttttued on Reverse hereof) <br />Signed: <br />Date ta't' i' 1 q 1) <br />----------------------------------------- <br />(For Distric Use Only) <br />Application approved by: <br />Application approved by: <br />for the <br />for Carter <br />Date of approval: -Z-ZZ-VS <br />Expiration Date of this approved application: tepZ Z - <br />Farms Water Control District <br />, Inc., Engineer for District <br />PERMISSION; WHEN GRANTED, WILL BE SUBJECT TO THE STANDARD PROVISOS <br />SET FORTH ON THE REVERSE HEREOF. <br />