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ILLINOIS ENVIRONMENTAL PROTECTION AGENCY <br /> DIVISION OF PUBLIC WATER SUPPLIES <br /> PERMIT SECTION <br /> 1021 NORTH GRAND AVENil�, EAST <br /> POST O�FICE BOX 19276 <br /> SPRINGFIELD, IL 62794-9276 <br /> APPLICATION FQR CONSTRUCTION PERMIT <br /> 1. Name of Public Water Supplies Decatur AirporUCity of Decatur, IL <br /> 2. Municipality or Township City of Decatur, IL �o��, Macon <br /> 3. Location of Project Decatur Airport, Decatur, IL-Adjacent ta Airport Road and North Fork Road <br /> 4. Title of Plans Construcl Water Main <br /> Number of Constructian Drawing �`� <br /> �. Documents being submitted: <br /> ❑✓ Construction Permit Application ❑ Engineers Design Summary <br /> � Schedule A - Cost Estimate ❑ Schedule C-I-Well Drilling Only <br /> Q✓ Schedule B -Water Main Construction ❑ Schedule GII -Well Complerion <br /> ❑ Specifications ❑ Permit Fee(Water Main Only) <br /> ❑ Construction Drawings <br /> 6. Scope of Project: Construdion of a new 8-in PVC water main to replace an existing 4-in water main,#o <br /> provide Aircraft Rescue and Fire Fighting {AF2FF)water to the Airport. <br /> 7,0 ILLINOIS COMMERCE COMMISSION CERTIFICATION(For privately owned water companies) <br /> 7.1 Has appiication beea made to the Illinais Commerce Commission for a Certificate af Public Convenience and Necessity? <br /> ❑ Yes []✓ A10 <br /> S.0 New Public Water supplies: Where the develaper intends to retinquish ownership of a new public water suppty to the <br /> homeowners served by that public water supply,he must submit to the Agency a copy of the Protection Cavsnants for <br /> effecting the traresfer. Those Covenants must be appraved by the ICC aud should accompany this appiication. <br /> 9.0 Infringement on Existing Public Water SuppIies: <br /> 9.1 Wili any part of this project be located within the boandaries of an arca served by another public water <br /> supply? ❑Yes �✓ No <br /> 9.2 If yes,name of that water supply <br /> This Ageney is authorized to require this inFormation under <br /> Ilfinois Compiled Statutes,1415 ILCS 5139(199$j.Discbsure of <br /> lhis information is required under that Section.Failure to do so <br /> may prevent this form from being processed and could result in <br /> your application being denied.'fhis form has been approved by <br /> IL 532otacrnwsa3 REv.8ti9� PRIMEDONRECYCLEPPAPER the Fomis Management Center. <br />