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<br /> <br />RICE CREEK WATERSHED DISTRICT'S <br />URBAN STORMWATER REMDIATION COST"SHARE <br /> <br />PROGRAM ApPLICATION <br /> <br />Incomplete tlppli'Qtions will be returned to the applicant. <br /> <br />I. ApPUCANT INFORMATION <br />Organization (to be named as Grantee): C ;~y or C.",lu-,,; lie. <br />Street: 1&&0 M..~.. ~~. <br />City, State, Zip: C,^l..",;\I., "" ~ 5S03& <br />Email and website: c\\o.r$.~ @ u....h,...:\\, ~...c._ <br /> <br />www. ~,..h.,,:\\e ""'". .a....... . <br /> <br />II. PROJECT CONTACTS <br /> <br />Project Officer: 0..\\ 0.' L." .... <br /> <br />Telephone: G.SI- ~u- an2. <br /> <br />Fax: ..sl' 4U- &(.t, <br /> <br />Email: ~\..r~...tiu...hn:\l.._....Co........ <br /> <br />Tax Status: ,,^,,"'~~:p..\ U" por"~;.1I\ <br />(e.g., local government, 501(c)(3) etc.) <br /> <br />Financial Officer: .}."'Wl M..y&t <br />Telephone: (,,&1''42' - .uU <br />Fax: c..fll. ~n . ac- n <br />Email: .3-"'/'''' @ C&"'~c.r":\\"W\II\. CoO,^" <br />Tax 10#: Cot' I ~t. 70 l"i <br /> <br />III. PROJECT INFORMATION <br />Project Name: C"II\~""';\\" <br />Location(s) of Project: <br /> <br />D.....o/\+o...,1I\ ~~J."...l.r"'^&"'''' <br />City: c..",h.,.,,;l\c. <br />State: M tJ <br /> <br />County: A", ok 0. <br />Project Completion Date: F..l\ 2008 (~h ..u I) <br /> <br />Project Start Date: ~r";oI\3 ~()O& <br />Project Type: (check only those that directly apply): <br />iii Redevelopment Project <br />o Roadway I Street project <br /> <br />t8I <br />o <br /> <br />Storm Sewer I Storm water Project <br />Other (list) <br /> <br />IV. COST-SHARE REQUEST <br />Cost-Share Funds Requested: <br />Total Contributions from Partners: <br /> <br />Total Project Cost: <br /> <br />s <br />s <br />S <br /> <br />$ <br /> <br />50.000 <br />I/B :5"co <br />I <br /> <br />(cash) <br />(in-kind) <br /> <br />/"6 ~c <br />. <br /> <br />V. SIGNATURE OF ApPLICANT (An original signature poge must be received with this application) <br />I certify that the information on this application is true and accurate. <br /> <br />Signature of Executive Director or Project Officer <br /> <br />Date <br /> <br />Name, Title <br />