Date:
Owner/Agent:								Phone:
911 Address
	Street					City		State		Zip
Social Security # or Federal ID #:
Tract				Section		Township		Range
(Attach an aerial photo and mark area)
Soil loss before				Soil loss after			Acres Treated
Assisted by:				Cost share %
		feet of NB terraces @			$   1.19	ft			$                    -
		feet of BB terraces @			$   1.19	ft			$                    -
		feet of GBS terraces @			$   1.19	ft			$                    -
		cu yd ponds/grade stabe			$   1.32	cubic yard			$                    -
		cu yd basin			$   0.80	cubic yard			$                    -
		5" Intakes @			$105.00	each			$                    -
		6" Intakes @			$139.00	each			$                    -
		8" Intakes @			$185.00	each			$                    -
		6 x 20 outlets @			$100.00	each			$                    -
		8 x 20 outlets @			$125.00	each			$                    -
		10 x 20 outlets @			$167.00	each			$                    -
		12 x 20 outlets @			$203.00	each			$                    -
		feet of 4" tile @			$   1.13	ft			$                    -
		feet of 5" tile @			$   1.30	ft			$                    -
		feet of 6" tile @			$   1.57	ft			$                    -
		feet of 8" tile @			$   2.33	ft			$                    -
		feet of 10" tile @			$   3.53	ft			$                    -
Total Estimated Cost-share				$                            -			Total Estimated Cost		$                    -
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                  of bill or estimate, whichever is less. If you have questions, do not hesitate to call 712-374-2014.