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COLORr'l RIVER BASIN SALINITY CONTROL r-'lGRAM Cost-S~ Assistance ~Dlication. At!reement, and Pa "laim D... Landowner seD Contract. Page 1 of 6 IN ACCOUNT WITH THE 0312001 Delta Canal Company DELTA SeD Soc. See. or To Ident. No. Address 84-1245391 477 -1600 Road. Delta, Colorado 81416 we) the undenligncd. do hereby request cost.share IlSSlIt8nceto help defray the cost ofi.rutaJlmgthc soil llfld water conservatton pre~es as lISted below. It t! understood and agreed that: Bdon rH.ivluJ RaY cost..hare ru.ads.lt will be Dee......,. ror the landoWDer(s) to sip the _anemeat below relating to th. malDte.aaee or pndlen III.talled. P...dku Dlust be plallaed aad Installed In aCeGrcl8a~ 'fritb technical specifications 01 !be Natural Rnoun:ts ConSfrvlltloD Se.....lce (NRCS). Tbe rnpoaslble tltCbalclaa mild make prior determlnaUoa that tbe pradlcn are feaslbl. 011 tb, .It, wben they an to be Installed, that thty an properly planned ADd in.talled, aad tbat ..Ihaates 01 qwatitin an proper aad reasonable. it'Db or cost 'or which reimbursement is laler claimed are 10 IN supported by dOC'lImellbdoll 01 pa)1llrbb. ruade or due to coatnrodon or otber "orbn. Thls appllcatioa -.111 Dot IN enrdive uadlllpprovnl by tbe Soil Con.wrndoa DI.trId (SCD). Claims ror paymral will aol IN acnpled ruore tIIaa alae (9) ruoatbs rromlbe date thls appllcatioa is approved; ualeu. aa emasloa is craaled by lb. SCD. Malhaaru relrubunemeat will be Ilmllril to tII. pernal agrnd apoa, aollo eleNd 70% or Ib.. adual c:t>>t to Ihe IlIlIdowurr, tbe perceatar oIav'tar ~Is lpecllled below; or,lbe 1I.01l1lt obllptril by Ibe SCD, .blcbewer Is Ibe lea.1. OCATION OF PRACTICE: E 1/2, SEe 25.30, TWP 15 S. RNG. R96W. R95W. DELTA COUNTY ORUM 2000 FUNDS CONTRACT # 20??oo5 APPLICANT'S REQUEST PRACTICE UNITS PERFORMED AVG MAXIMUM COST- COSTI ASSISTANCE SHARE RATE SHARE: EXTENT X YEAR PRACTICE UNIT EXTENT UNIT % $ YEAR EXTENT AVG _% SMALLEST ACT RATE 2001 587-STRCTR eIN# FOR WATER 1 CONTROLL IA Concnte, Fnnd Cubic Yard 14.0 6S0,OO 70 6.370,00 & Reinforced 18 Gate, Head Dia.Inch 48" SO,OO 70 1,680,00 (I X 48") If you need more space, please attach a separate sheet. (8,050.00) TOTAL $ TOTAL $ LESS OTHER COST -SHARE ASSISTANCE $ SIgnature of Landowner or Authorized Rep Date TOTAL AMOUNT LANDOWNER CLAIM $ Practices and Quantities requested are needed and practical and will LANDOWNER(S) CERTIFICATION AND AGREEMENT: be planned in accordance with NRCS technical specifications. I certify that the items for which payment is claimed were furnished and that the charges are reasonable, proper, and correct, and no part of the claim has been paid. I further certify that I am the owner of the above described property and agree that if any or all of Signature of Technician Date above installed practices shall be removed, altered, or modified so as to lessen their effectiveness without consent of the SCD for the Mlifespan of the practice(sr after the APPLICATION APPROVAL: date of receiving payment, that portion of the claimed amount shall be refunded to the SCD. If title to this land is transferred to another party, it shall be my responsibility to advise the new owner that this agreement is in force and to obtain such new owner's The SCD Board of Supervisors approved the Applicant's Request and acceptance of the responsibilities herein. The attached plan/schedule of operations hereby obligate $ , prepared by the NRCS Is hereby made a part of this agreement. Signature of Landowner(s) Oato SiQnature of sea Reoresentative Date COMPLETION AND DOCUMENTATION CERTIFICATION: SOIL CONSERVATION DISTRICT CERTIFICATION: I hereby certify that the above claim has been reviewed by me and I find it iii proper claim against the Delta SeD Salinity Control Cost Share Program fund. Signature of Technician Date Authorized Signature Date Sionalure of SeD Representative Date ev,10199 " Ii t cj w He \( C, t. , PlollC,S Pfl'iM{,)!'