Date:

Owner/Agent:											Phone:

911 Address
		Street							City			State		Zip

SS # or Federal ID #:

Tract					Section			Township		Range
			SELECT			SELECT			SELECT
	(Attach an aerial photo and mark area)

	Cost share %								Soil loss before
									Soil loss after
Assisted by:									Acres Benefited

						ESTIMATE					ACTUAL

$ 1.45	ft		NB terraces					$ -					$ -

$ 1.45	ft		BB terraaces					$ -					$ -

$ 1.45	ft		GBS terraces					$ -					$ -

$ 1.45	cu yd		ponds/grade stabe					$ -					$ -

$ 0.95	cu yd		basin					$ -					$ -

$ 130.00	each		5" Intakes					$ -					$ -

$ 155.00	each		6" Intakes					$ -					$ -

$ 175.00	each		8" Intakes					$ -					$ -

$ 120.00	each		6 x 20 outlets					$ -					$ -

$ 140.00	each		8 x 20 outlets					$ -					$ -

$ 180.00	each		10 x 20 outlets					$ -					$ -

$ 225.00	each		12 x 20 outlets					$ -					$ -

$ 1.25	ft		4" tile					$ -					$ -

$ 1.45	ft		5" tile					$ -					$ -

$ 1.75	ft		6" tile					$ -					$ -

$ 2.60	ft		8" tile					$ -					$ -

$ 3.90	ft		10" tile					$ -					$ -

$5.30	ft		12" tile					$ -					$ -

		Total Project				Estimate		$ -			Actual		$ -
		Total Cost-share				Estimate		$ -			Actual		$ -

Keep in mind that existing terraces must meet specifications. If they do not, we will start with the top terrace and work down.Terraces MUST BE STARTED no later than 30 days after layout. Funds may be cancelled if work is not started within 30 days of layout. No extensions will be granted without prior approval by Fremont County Soil and Water Conservation District. The landowner is only guaranteed up to 50% of bill or estimate, whichever is less. If you have questions, do not hesitate to call 712-374-2014.