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<br />.--::;:-. <br />~ <br />Page \ <br />AD-245 <br />(99-\ \-95) <br /> <br />U.S. DEPARTl'ENT IF AGRIOl.TlJlE <br />REQlEST FOR COST-SHARES <br /> <br />FORM APPROVED <br />llt1B NO. ac..se-0082 <br />1ST. ~ CO. ~ CID I CONTROL NO. (F /Y ~ NO,) 1 <br />I eae75S I 960023 I <br /> <br />(AD-245 replaces ACl'-24S and SIP-245) <br /> <br />FARM NO. <br />2919 <br />TRACT No, <br />4823 <br /> <br />NAHE AND ADDRESS <br />BRAVO DITOl CO INC <br />PO BOX 186 <br />. ILIFF, CO ea736 <br /> <br />I FAAIUIID I PROGRAM I FUND I CONTRACT /L TA I <br />I Le I CODE I CODE I ~ ITEM NO, I <br />I 1 I I I <br />I CRIlPI.ANIl I I I I <br />I I I I I <br />I I ECPF I I I <br />I I I I I <br /> <br />PRIMARY <br />PURPOSE <br /> <br />I OTHER <br />IFARlIS <br />1/ /YES <br />IIXINo <br />I <br />I <br />I <br /> <br />EROSION <br /> <br />Telephone No. <br />DESCRIPTION IF PRACTICE OBJECTIVE <br />REPlACE 49FT IF wm:TE STU:llIlE <br />PRACTICE LOCATION LFP FARlI <br />FOR USE BY THE APPRlIVIM; OFFICIAL <br />I <br />Number I Practice Title <br />- A -I B <br />EC4 Restore struc and other installations (AS) <br />4IIl I STRlICTIJlES <br />! <br />1 <br />I <br />I <br />I <br />I <br />CONSERVATION PlAN: <br /> <br />No <br /> <br />I Extent I Extent I I CIS I I plan to <br />I R!!,\uested I Approved I Rate I Approved I start the <br />1- C -1- D -1- t ~J..- F -1 practice <br />m,e I I ""'Y;f, I 1\-I:r-~ <br />I Lei I -I I <br />J I I I 1 <br />I 1 I 1 1 <br />I 1 1 I I I plan to <br />I I I I I cCllp lete the <br />I I I I I practice <br />I I I I 1 e6-1:r-~6 <br />Other Plan I PMTNERSHIP / /Yes /X/No <br />/ /Yes IXINo I Joint Venture / /Yes /X/No <br /> <br />F ara Plan By NRCS <br />/X/Yes / /No <br /> <br />Forest Plan By FS <br />/ /Yes IXINo <br /> <br /> <br />Al'PLICANTS REQUEST <br />I rl!'luest cost-share assistance 11nder the prograa to aeet the objective described abOlle, This practice lIQuid not be perforted <br />without Federal cost-sharing. If cost-shari1l9 is approved for the practice re<\uested, I agree to refund all or part of the funds <br />paid to IIIe as determined by the Approving Offlcial, if, before eX~iration of the spenfied practice lifesean I, la) destroy the <br />approved practice, or (bl 'IOluntanly relinquish control or title to the land on lIilich the approved practice has been established <br />ailil the new QlI1ler and/or operator of the land does not agree in writing to properly aaintain the practice for the reeainder of <br />its lifespan. I have not yet started this practice, and except for EO'r!!,\uests, I understand that if I besin the practice before <br />receiving oritten approval I !'k1y be denied funding. I authorue a representative of USDA to have access to the practice site area. <br />I understand that fora 'CONTIftJATION FOR AD-24S' is by reference incorporated herein, <br />I DATE: I Estiaated $ -Y44bo I CIS Willing $ :J'.'9~-'= <br />I I CIS Value ~ I to ApprOlle r-- <br />I/O-:.J/fS I I //.d-~ -9, m If. <br />icial approved the extent shown in BLOCK D abOlle and the cost-shares shown in BlOCK F abOlle for <br /> <br />FOR THE APPROVING <br />OFFICIAl <br />REMARKS <br /> <br />I DATE: <br />I <br /> <br />I Practice Expiration <br />I Date <br /> <br />/C}.-tf- 95'" <br />~ 1/~ /S'I !r7' ;t<?(;J 1 43~ /10'" <br />-yyr~ tJ~ <br /> <br />For SIP and FIP Only: I certify that I / /do / /do not own more Ieee acres of eligible <br />forestland in the United States or any territ.cry or possession of the US. <br />SIGNA1UlE: DATE: <br /> <br />IAcres if !lOre <br />Ithan 1,009 <br />I <br />I <br /> <br />IDate Waiver <br />I Approved <br />I <br />I <br /> <br />PAJ(IlCIPAIIUN IN USDA P~"lJ{,AAIl.\ IS IJf1:N IU ALl. 1:l.1('11:ll.L Ai"'PLlCANIS WllHUUI ~1.AKIl IU RACC., ClLUl(, 1I'l:l.1('lUN, NAIl\JllAL Ul(l('lN, 1\1.I:., <br />SEX, l'AAITAl STATUS, OR DISABILIlY. <br />