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STATE OF NORTH CAROL"INA _ <br /> Department of Human Resources • Department of Natural Resources and Cammunity Deve <br /> Division of Health Services Division of Environmental Management <br /> .'.PPLXCATION FOR STATE GRANT UNDER THE CLEAN WATER BOND ACT TO BE FILLED IN BY STATE <br /> 1977, AS AMENDED, FOR CONSTRUCTION OF WASTEWATER TREATMENT DATE RECEIVED <br /> aKs, WASTEWATER COLLECTION SYSTEMS AND WATER. SUPPLY SYSTEMS <br /> To be submitted in duplicate PROJECT NUMBER <br /> See INSTRUCTION before completin a plication <br /> SECTION I - REQUEST FOR STATE GRANT <br /> I. LEGAL NAME AND ADDRESS OF APPLICANT 2. TYPE OF PROJECT(Check Ong <br /> Name THE COUNTY OF ORANGE Wastewater Treatment <br /> Street. 106 B. Margaret Lane P. O. Bog. ;{ Wastewater Collect±ol <br /> System <br /> City Hillsborough,, tdc Zip Code 27273 <br /> • ri Supply System <br /> Telephone Number (919) 732-8181 . <br /> ' 3. PROJECT TITLE 4. TOTAL STATE GRANT REQUES' <br /> FOR THIS PROJECT <br /> The above named Unit of Government (herein called the <br /> "APPLICANT") hereby makes application to the State of $ 66,575 <br /> 'North Carolina (herein called the "STATE") for State <br /> grant assistance as herein indicated- in the construc- 5. ALLOCATION FROM WHICH GR <br /> tion of IS REQUESTED <br /> Efland Estates Sewer System <br /> a. [xJ County Allocatiol <br /> herein called the "PROJECT") Amount $ 66,5751 <br /> 7. CERTIFICATION <br /> County Amoun <br /> • <br /> The attached statements and exhibits are hereby made <br /> part of this application and the undersigned repre- Orange _ e 66,E <br /> sentative of the Applicant certifies that the infor- <br /> mation in the application and the attached statements $ <br /> • <br /> and exhibits is true, correct,, and complete to the <br /> best of his knowledge and belief. He further certi- , $ <br /> flee that: He has been authorized to file this appli- <br /> cation by formal action of the governing body of the $ _ <br /> Applicant as is evidenced by the ATTACHED CERTIFIED <br /> COPY OF AUTHORIZATION MADE BY THE APPLICANTS GOV- _ $ <br /> ERNING BODY; the governing body of the Applicant agrees <br /> that if a State grant for the Project is made pursuant b. 1 1 Statewide Alloca <br /> to the Clean Water Bond Act of 1977, as amended, the <br /> Applicant will arrange financing for all remaining Amount $ <br /> costs of the approved Project; the Applicant will pro <br /> vide proper and efficient operation and maintenance of 6. TYPE OF PAYMENT REQUESTS <br /> the approved Project after completion of construction <br /> thereof; and the Applicant has substantially complied n Lump Sum <br /> or will substantially comply with all Federal, State, <br /> and local laws,' rules, regulations, and ordinances I X 1 Progress <br /> applicable to the Project. <br /> 8. NAME AND TITLE OF REPRESENTATIVE 9. SIGNATURE OF REPRESENTATIVE 10. DATE <br /> RICHARD E. WHITTED, CHAIRMAN <br /> BOARD OF COUNTY COM1ISSIONERS <br />