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Page 2 of 2 <br />APPLICANT SIGNATURES <br />The landowner's signature indicates their agreement to: <br />1. Grant the RSWCD's representative (s) access to the parcel where the conservation practice will be located. <br />(initial /date ). <br />2. Obtain all permits required in conjunction with the installation and establishment of the practice prior to starting <br />construction of the practice. <br />3. Be responsible for the operation and maintenance of conservation practices applied under this program in accordance <br />with an operation and maintenance plan prepared by the RSWCD's technical representative. <br />4. Not accept cost -share funds from RSWCD sources that are in excess of 50 percent of the total cost to establish the <br />conservation practice. <br />Date <br />Landowner <br />Address and Phone Number <br />(illy/State/Zip Lode <br />CONSERVATION PRACTICE <br />The conservation practice category for which cost -share is requested is <br />short m t bebt 'i - kL tc F 'Lc) . <br />The estimated practice cost is $ (1 00 oc <br />TECHNICAL ASSESSMENT AND COST ESTIMATE <br />I have reviewed the site where the above listed conservation practice (s) are to be installed and find that they are needed and <br />that the estimated quantities and costs are practical and reasonable. <br />RSWCD Technical Representative <br />Date <br />-1 -a3 <br />AMOUNT AUTHORIZED FOR COST -SHARE <br />Cost - sharing not to exceed $ 6700 e9 on the basis of 50 percent of the cost estimate. <br />1 RSWCD Administrative /Board Representative <br />CERTIFICATION OF PRACTICE INSTALLATION <br />Board Meeting Date <br />RSWCD Technical Representative <br />Date <br />AMOUNT AUTHORIZED FOR PAYMENT <br />The amount authorized for payment is $ <br />RSWCD Administrative/Board Representative <br />Board Meeting Date <br />