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<br />COLOR
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<br />') RIVER BASIN SALINITY CONTROL' ')GRAM
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<br /> Cost-S. ~ Assistance All plication, Altreement. aDd Payn. ,Claim
<br /> Da" Landowner SeD Contract, Pale 4 of 6
<br />IN ACCOUNT WITH THE 0312001 Delta Canal Company
<br />DELTASCD Soc. Sec. 01' Tax Ident. No. Address
<br /> 84-1245391 477 1600 Road. Delta. Colorado 81416
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<br />I (we) Ihc undersigned, do hereby request co.t-shara auistance to help defray the cost ofinstlJUinllho toil and water COJUefVBtion pm::tlCes u }j,ted below. It is undemood and agreed that;
<br />1. Bern... "",,lvlolaoy cost-sb.re rud..lt will be llectAal')'ror tbelaodowa.r(s) to sip tb. agreem.ot below relaUol to tb. ..aloteDuce or pl'8ctlces IDstallfti.
<br />2. Practicn mu.t bt plaDoN aad lo:dalled I.. .ceerdaac. wltb technical spedflC1lldoas of lb. Nahu'al RHOUR" CODstnalloD Service (NRCS).
<br />,. The rnpoDslbl. '"boldla. musllll.au prior delerm.lnatioo Ihat lb. practices are rea:t1ble 00 Ib, ,Ite wbere Ihey are to be 10lialled, tbat tbey are properly plaaoed
<br />aDd losbllled, and lbat .stlmate. or quaatitles.... proper aad realoDabl..
<br />~ Items of c:0'-1 tor wblcb n:lmhunemeat is later dahned an to be supported by docull1eatatloa of JQlymeais made or due to coatnu:tora or other workel'l.
<br />5. This appllQtioa. wUIIlGt." tlTtdln _U1 apprG-v.d by tb, SoU Coasenatma. District (SCD}. C'aillM (or pG.)'1IHl1i win DOt" ac<<p-ted mon thaa. a.ilK (9) ..aitt.
<br />from the date this application d approved. allleu, aa emmoa Is enaled by the SeD.
<br />6. Muhnum relmhuraemeat will be Ihalttd to the perceat arreed UllOa. aot to euNd 70~ of tbe aciual cost to the landoWller; the peReatap of average I:O$U
<br />spectned below; or, th, amouat obllpled by tb, SCD, wblehev,r Is the l~t.
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<br />LOCATION OF PRACTICE:~, SEC 25,30, TWP 15 S. RNG, R96W, R95W, DELTA COUNTY
<br />FORUM 2000 FUNDS CONTRACT # 2000005
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<br /> APPLICANT'S REQUEST PRACTICE UNITS PERFORMED
<br /> Ava MAXIMUM COST-
<br /> COSTI 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 />4 CONCRETE
<br /> DTCH & CNL
<br /> LlNlNG
<br />4A Cncrde Dtdt, 2" Foot 3300 10,70 70 24,717,00
<br /> ( I'Botlom) ,36"
<br />48 Concrete Drop Each 33 90,00 70 2,079,00
<br /> Structures
<br />4C Earthwrkffmching Foot 3300 3,00 70 6,930,00
<br /> Adverse Conditions
<br />4D Pipe, Corrugated Dia. lnIFt 8819 1,05 70 6,481.96
<br /> Metal>= 15"
<br /> (42"X210)
<br /> If you need more space, please attach a separate sheet.
<br />{4Q,207.96) TOTAL $ TOTAL $
<br /> LESS OTHER COST -SHARE ASSISTANCE $
<br />Signature of Landowner or Authorized Rep Date 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 wflich payment is claimed were furnished and that the charges
<br /> are reasonable, proper, and COlfoct, and no part of the claim has been paid. I further
<br /> certify that I am the O'Mler of the above described property and agree that if any or all of
<br /> Sign,ture of Technicia? 0.10 above installed practices shall be removed, altered, or modified &0 as to lessen their
<br /> effectiveness without consent of the seD for the "lifespan of the practice(s)" after the
<br />APPLICATION APPROVAL: date of receiving payment. that portion of the claimed amount shall be refunded to the
<br /> SeD. 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 Request and acceptance of the responsibilities herein. The attached plan/schedule of operations
<br />hereby obligate $ .. prepared by the NRCS Is hereby made a part of this agreement.
<br /> Signature of Land()lM"ler(s) Date
<br /> SiQnature of SCO Reoresentative Dat.
<br />COMPLETION AND DOCUMENTATION CERTIFICATION: SOIL CONSERVATION DISTRICT CERTIFICATION:
<br /> I hereby certify that the above claim has been reviewed by me and I find it a proper claim
<br /> against the Delta SeD Salinity Cc)ntrol Cost Share Program fund.
<br /> Signature of Technician Dale
<br /> AuthoriZed Signature Dale
<br /> SiQnature of seD RePresentative Dale
<br />Rev, 10199
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