Engineering Asst. Application

Request for PACD Engineering Assistance

Office Use Only:
ID # _____________________

Type of Project: Agriculture (Please complete additional CNMP supplement form)
                          AMD
                          Stream Corridor Restoration
                          Other (describe) _______________________________________________

PART I (Applicant)

Sponsor Name: __________________________________________________________________

Sponsor Address: ________________________________________________________________

________________________________________________________________

Phone: ___________________ Fax: ___________________E-mail:_________________________

Contact Person: ________________________________________Title:______________________

Name of Project Landowner or Unit Owner: ____________________________________________

Landowner Address: ______________________________________________________________

Landowner Phone: ________________________________e-mail or fax______________________

Have land rights been secured in writing? Yes No

Watershed (8-digit hydrologic Unit)_ _ _ _ _ _ _ _

DEP Watershed Manager: _____________________________

County: _____________________Conservation District Watershed Specialist: __________________

PART II (Applicant)
Type of Grant:	Grant Status:	Growing Greener Eligibility (n/a if CNMP):
Growing Greener	Grant Approved Grant Expiration Date:______	Watershed Organization
319 ME#_____________________	Grant Pending	County Conservation District
Other Grant Specify ___________________	Applying for Grant	Non-Profit Organization 510 (c)(3)
		Counties, municipalities, their subdivisions
		Educational Institution

Specific Description of Project: _____________________________________________________

______________________________________________________________________________

Have you included funding for engineering in your grant? Yes No

Have you contracted for this engineering? Yes No

Type of Technical Assistance Requested:
Watershed Assessment	Soil Investigation	Constructing Quality Assurance
Inventory and Evaluation Report	Design and Specifications	Training
Topographic Survey	Technical Reviews	Other: _______________

Signature: ____________________________ Affiliation: _________________________________

Today's Date: _________________________ Approximate Date Needed: ____________________

Please submit one copy to the NRCS Technical Center and one copy to the County Conservation District.

PART III (Conservation District)

Conservation District Comments: _____________________________________________________

______________________________________________________________________________

Conservation District Priority: High Medium Low