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<br />COLOR' ) RIVER BASIN SALINITY CONTROL r ')GRAM <br /> <br /> Cost-S.' ~ Assistance At IicatioD, reement, and Pam Claim <br /> Date Landowner SeD Contract, Page 2 or 6 <br />IN ACCOUNT WITH THE 0311001 Delta Canal Company <br />DELTASCD Soc. See. orTaxldent. No. Address <br /> 84-1245391 477 1600 Road, Delta. Colorado 81416 <br /> <br />I (we) the undenigned. do hereby rcquost Qost-ahare wistance to help defny tho cost of installing tho toil and water COllSeNatWn practices as listed below. It is Wldentood and agreed that <br />t. Beron nulvbllaa)' eost-ahan 'uads, it will be IIech3aI'1 for tbelaadoWD.r(.t) to .IID the aan.meal below ~Iatiog to th. malatenSDr. of practices la...Ued. <br />1. Practices must be plaaaed aad lastallN 10. accordlUlCe wl.th tedmlcal. spec-ItkaUou 01 the Nlltll.l"llt Rnoaru, Coasen'atioa Sen'lc:e (NRCS). <br />J. Th. rnponslble tKbaldaa mu,t make prior det.rmllUltloD tbat the practices an Inslbl. OD the sll_ "here they an to be l.stalled,lh.. tb.y are properly pl.DaN <br />aad hpllllled, aDd tbat ..tlmatn 01 qaaDUd" an proper aod reasoaable. <br />4. Items ot t1)1t for whleb relmbun,au'D. Is later clahD" an to be supported by documentallon 01' payments lAade or due 10 coDtradon or olber worke.... <br />5. Tbls appllcatloa will Dol'be efTedln untllapprol'td blahe Soil CODSenatloa Dlslrld (SCD). Cllllau for paymeal will aol be a",pted more lhan aiDe (9) mODlbs <br />from lIIe dale Ihls applicatioa is app",~ed; lIa1eu" aD uleaslo. Is (Vanled by Ihe SCD. <br />6, Mnlmam reimbursement will be llralted 10 lhe perce.1 a&reflI apoa, nol to u<<ed 70% 01' Ibe .ctuateost 10 the landowner; the perceatap or .o.",ral' eosls <br />lpeelfled below; or, the amouat obllpted by the SCD, whichever II Ibe least. <br /> <br />LOCATION OF PRACTICE: E 1/2, SEC 25,30, TWP 15 S. RNG, R96W. R95W. DELTA COUNTY <br />FORUM 2000 FUNDS CONTRACT # 20??oo5 <br /> <br /> APPLICANT'S REQUEST PRACTICE UNITS PERFORMED <br /> Ava MAXIMUM COST- <br /> COST! ASSISTANCE SHARE RATE SHARE: <br /> EXTENT X <br />YEAR PRACTICE UNIT EXTENT UNIT % $ YEAR EXTENT AVG _% SMALLEST <br /> ACT RATE <br />2001 428A NON <br />CIN# REINFORCED <br />2 CONCRETE <br /> DTCH & CNL <br /> LINING <br />ZA Cncrete DIdi. Z" Foot 1900 10,70 70 14,Z3LOO <br /> ( I 'Bottom). 36" <br />ZB Earthwrkffmdling Foot Z30 3,00 70 483,00 <br /> Adverse Conditions <br />ZC Pipe, Corrugated Dia. In/Ft 3360 1.05 70 Z,469,60 <br /> Mttal>= IS" , <br /> (4Z"X80') <br /> If you need more space, please attach a separate sheet. <br />(17,183.60) TOTAL $ TOTAL $ <br /> LESS OTHER COST -SHARE ASSISTANCE $ <br />Signature of landa.vner or Authorized Rep Oate TOTAL AMOUNT LANDOWNER CLAIM $ <br />Practices and Quantities requested are needed and practical and will LANDOWNER(S) CERTIFICATION AND AGREEMENT: <br />be planned in accordance with NRCS technical specifications. I certify that the items for which payment is claimed wore furnished and that the charges <br /> are reasonable, proper, and correct, and no part of the claim has been paid. I further <br /> certify that I am the owner of the above described property and agree that If any or all of <br /> SignaMe 01 Technician Dale above installed practices shall be removed, altered, or modified &0 as to lessen their <br /> effectiveness voAthout consent of the SeD for the "'ifO$pan of the practice(s)" after the <br />APPLICATION APPROVAL: date of receiving payment, that portion of tho claimed amount shall be refunded to the <br /> . SCD. If title to this land is transferred to another party, it shall be my responsibility to <br /> advise the new owner that this agreement is in force and to obtain such new owner's. <br />The SeD Board of Supervisors. approved the Applicant's RequO$t and acceptance of the responsibilities herein. The attached plan/schedule of operations <br />hereby obligate $ prepared bythC!l NRCS is hereby made a part of this agreement. <br /> Signature of landowner(s) Oate <br /> SiQnature of sea Reoresentative Oate <br />COMPLETION AND DOCUMENTATION CERTIFICATION: SOIL CONSERVATION DISTRICT CERTIFICATION: <br /> I hereby certify that the above claim ha$ been reviewed by me and t find it a proper claim <br /> . against the Delta SCD Salinity Control Cost Share Program fund. <br /> Signature of Technician Oate <br /> Authorized Signature Oate <br /> SiQnature of seD Representative Oate <br /> <br />Rev, 10199 <br />