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APPLICATION FOR CONSTRUCTION PERMIT PAGE 3 <br /> 10.3 The Water Main Permit fee does not apply to: <br /> a) Any Department,Agency or Unit of State Government. <br /> b) Any unit of Local government where all of tt�e following conditions are met; <br /> 1) The cost of the installation or extension is paid wholly from monies of the unit of local govemment,state <br /> grants or loans,federal grants or loans,or any combination thereof. <br /> 2) The unit of local govemment is not given monies,reimbursed or paid,either in whole or in part,by another <br /> person(except for State grants or loans or federal grants or loans; ' <br /> and <br /> 3) I/We <br /> nit o oca goveroment s�gnemre o au �o o icia <br /> hereby certify that subsections 103(b)(1)and 103(b)(2) have been met. <br /> 10.4 Agreement to Furnish Water(This section must be completed if applicable) <br /> The <br /> iry, own, � age, a er ompauy or ater ut onty <br /> has agreed to furnish water to the area in which water main extensions are proposed by <br /> ve oper <br /> according to plans titled" " <br /> prepared by <br /> gmeen�g mn <br /> The undersigned acknowledges the public water supply's responsibility for examining the plans and specifications <br /> to determine the proposed extensions meet local laws,regulations,and ordinances. <br /> Date: By: <br /> ignaNre o u onze u ic ater upp y aa �t e) <br /> 10.5 Certification by Owner(s)of Completed Public Water Supply Improvement(s) <br /> UWe hereby certify that I/We have read and thoroughly understand the conditions and requirements of this ' <br /> submittal. UWe hereby agree to accept ownership of the project upon satisfactory completion. <br /> City of Decatur <br /> 10.6 AUTHORITY TO SIGN APPLICATION <br /> 10.6.1 Applications signed by a person other than a responsible municipal official, corporation officer,or owner, <br /> must be accompanied by evidence of authority to sign the application, unless documentation of such <br /> authority is on file with the Division of Public Water Supplies. <br /> 10.6.2 Evidence of authoriry to sign the application on field with this Division �✓ Yes ❑ No <br />