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APPLICATION FOR CONSTRtICT1C)N PI;.RMIT PAGE 2 <br /> 9.3 Describe tliat partion of the project within Ch�boundari�.s af the other public water supply <br /> 10.0 CLR'TIFICATIONS <br /> 10.1 Certificate Uy Design Engineer <br /> I hereby certify that.T 1n1 famili�r wittx the informAtion contained iii this flpplication, and that to the best of my <br /> knowledge and belief such informatiou is tn�e, complete and accurate. <br /> Patrick F. Wilson 062-058444 <br /> , , , . <br /> Homer L. Chastain &Associates, LLP {217)422-8544 <br /> , ... <br /> 5 N. Country Club Road Decatur, IL 62521 <br /> ` ,���-y�. �`r���".,�� <br /> � <br /> 10.2 Ccrtificate by Applicant(s) <br /> Commencing January 1, 1990, 5ection 16.1 of the Environniental Protection At(Ill.Rev. Stat. 1987, Ch. 111 <br /> 2,par. 1016.1, as amended by P.A. 86-67�)requires the agency to collect a f.ee for cerlain applications for the <br /> installation or extcnsion of water mains. There are no permits fees for other improvements to public water supply <br /> systems and only certain water main projacts will be affected. <br /> Iu accordance with the Act effeedve January 1, 199U,I/We hereby agree to pay the appropriate fee for this <br /> Petmit to install or extend Water main. Except for the conditions listed below in 10.3 the fallowing fee schedule shall <br /> apply: Note:The fee schedule has been modified to include the increased permit fees as authorized under Public Act 93-32. <br /> These fees are effective as of July 1,2003. <br /> Fee I.ength of�Vater main <br /> ❑ $ 0 200 feet or less <br /> 0✓ $240 Greater than 200 feet,but�iot more fhan 1,000 feet <br /> ❑ $720 Grealer than I,OOQ feet,but not more than�,000 feet <br /> ❑ �1200 Greater fhan 5,000 feet <br /> Please check the appropriate fee;make cheCk or money order payable to; Treasur�r, State oF Illinois and <br /> submit along�vith tllis application. Any fae remitted ta the Ageney shall uot be refunded at any time or for any reason, <br /> either in�vhole or in part. <br /> I/We hereby cerrif}�that UWa have zead and thoroughly understand the conditions and requirements of this <br /> submittal. 1/We he;reby agree to con£onn witl� the Standard Conditions and with any Special Coxiditiqns made part of <br /> this Construction Permit. All such Conditions sha11 be as authorized by the F.nvironmental Protectxon Act and the Rules <br /> adopted by the Pollution Control Board under authority granted by the Aet. <br /> Hospital Sisters Health System-St. Mary's Hospital <br /> 1800 East Lake Shore Drive Decatur, IL 62521 <br /> _ , " �f�.�/�� <br /> , � <br /> DA _ ' <br /> (,,��� �'�G✓� <br /> � <br /> Please note that Chapter 148 of the Ill.Revised Statutes Section 72 requires that a trust disclosure statement <br /> be provided when a tnistee of a land trusl malces applicltion to the State of Illinois for any pern�ii. <br />