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r. <br />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@sjnvmd.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 pertaining 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 Egret Marsh Regional Stormwater Park- (ATS) <br />A. APPLICANT INFORMATION <br />A4. Name of applicant Indian River County Public Works Department <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. SJRWiVID will send correspondence concerning this application ONLY to this person. <br />Name W. 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 />hMI <br />