Form 49367 - Application For Section 319 Nonpoint Source Pollution Grant
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8For Staff Use Only: FFY _____
APPLICATION FOR SECTION 319
NONPOINT SOURCE POLLUTION GRANT
State Form 49367 (4-99)
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
CLEAN WATER ACT SECTION 319
Nonpoint Source Pollution Management Program
Use this form to apply for Section 319 Nonpoint Source Pollution Grants.
This application MUST be typed and MUST be submitted on this form or an identical copy!
1.
Name of project:
2.
Name of organization sponsoring the project:
3.
Address of sponsor (number and street, city, state, ZIP code)
4.
Sponsor's taxpayer ID number:
5.
Type of organization (Municipality, County Government, State, Federal, University, Nonprofit):
6.
Primary contact person: Name and address; affiliation:
Telephone, FAX, e-mail:
7.
Project Coordinator, if different from #6:
Telephone, FAX, e-mail:
8.
Proposed start date (month, day, year):
Ending date (month, day, year)
9.
Project watershed and waterbody:
10.
NPS management plan objectives fulfilled by this project (see instructions):
11.
Total Section 319 funds requested:
$ _______________________________________
Plus Match Funds or In-kind Match Services
(25% or more of Total Project Cost):
$ _______________________________________
Equals Total Project Cost:
$ _______________________________________
12.
Has a Watershed Management Plan been completed for this watershed?
If no, will a plan be completed by Project End Date?
Yes
No
Yes
No
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