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APPLICATION FOR CONSTRUCTION PERMIT PAGE 3 <br /> 103 The Water Main Permit fee does not apply to: <br /> a) Any Department,Agency nr Unit of State Government. <br /> b) ?ury unit of Local gavemznent where all of the following conditions aze met; <br /> 1} The cost of the installation or extension is paid wholly from monies of the unit of local government,state <br /> grants or loans,federal grants or loans,ar any combination thereof. <br /> 2) The unit of local government is not given monies,reimbursed or paid,either in whole or in part,by another <br />, person (except for State grants or loans or faderal grants or loans; <br /> and <br /> 3} I/We <br />' n�t o govemment signature o onze o �c� }� <br /> hereby certify that subsections 10.3(b)(1)and 10.3(b)(2}have been met. <br /> 10_4 Agreement to Furnish Water(This section must bc completed if applicable) <br /> �� City of Decatur, tL <br /> �ry, own, gc, atcr ompany or aler u onty <br /> has agreed to furnish water to the area in which water main extensions are proposc;d by <br /> Decatur Airport <br /> � <br /> according to plans titled �� Construct Water Main « <br /> prepared by Hanson Professionai Services Inc., Springfield, IL <br /> ngmeermg um <br /> The undersigned acknowledges the public water snpply's responsibility for examining the plans and specifications <br /> to determine the proposed ext ions m t loc Iaws,re latio s,and ordinances. . <br /> Date:�Z-1��� By: '�ri �rt? i` � <br /> tgnature o c a upp, c�a � i c} <br /> 10.5 Certif'ication by Owner(s)of Completed Public Water Supply Improvement(s) <br /> I/We hereby certify that I/We have read and ihoroughly understand the canditions and requirements of this <br /> submittal. I/We hereby agree to accept ownership of the project upon satisfactory completion. <br /> Keith Alexandet, City of Decatur-Department of Water Management <br /> 1 Gary K.Anderson Plaza, Decatur, IL 62523 <br /> . <br /> ��������=��� �2��� <br /> Director of Water Management <br /> 10.6 AUTHORITY TO SIGN APPLICATION <br /> 14.6.I Applications si�ed by a person other than a responsible municipal officzat,corporafion officer,or owner, <br /> must be accompanieci by evidence of authority to sign the appIication,unless documentation of sueh <br /> authority is on file with the Division of Public Water Supplies. <br /> 10.G.2 Eyidence of authority ta sign the Application on field with this Division (_dj Yes ❑ No <br />