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Metropolitan Waste Control Commission <br /> Mears Park Centre,230 East Fifth Street, St. Paul, Minnesota 55101-1633 <br /> 612 222-8423 <br /> PERMIT NO. <br /> INTERCEPTOR 3- <br /> APPLICATION AND PERMIT <br /> FOR CONNECTION TO, OR USE OF, <br /> METROPOLITAN WASTE CONTROL <br /> COMMISSION FACILITIES <br /> (Note: this form must be submitted in duplicate) <br /> APPLICATION <br /> The City of hereby applies for a permit for <br /> connection to, or use of, Metropolitan Waste Control Commission .(MWCC) <br /> facilities. A. description of the proposed connection or use is attached to <br /> this Application as Exhibit A, Supplemental Data Sheet. By execution of this <br /> Application, the Applicant agrees to: <br /> 1. Provide such additional information as is requested by the MWCC. in <br /> order to make a determination on permit issuance. <br /> 2. Abide by the permit terms and conditions set forth below and all <br /> applicable state and local laws, ordinances, rules and regulations. <br /> 3 . Pay all applicable permit fees (i.e. , service -Availability Charge <br /> and . Industrial Strength Charge) in accordance with MWCC rules and <br /> regulations. <br /> 4.. . Reimburse the MWCC for any damages resulting to the . MWCC's <br /> facilities as a result of the connection or use of its facilities. <br /> 5. Indemnify and hold harmless the MWCC, its employees, agents, and <br /> contractors from and against all claims, damages, losses and expenses, <br /> including but not limited to attorney's fees, arising out of or, resulting <br /> from the connection. to, or use of, MWCC. facilities, provided that any such <br /> claim, damage, loss. or expense ' (1) is attributable to bodily injury, <br /> sickness, disease, or death or to injury to or, destruction of tangible <br /> property, including the loss of use resulting therefrom, and (2) is caused in <br /> whole or in part. by any negligent act or omission of the Applicant, its <br /> contractors, subcontractors, or anyone directly or indirectly employed by any <br /> of them, regardless of whether or not it is caused in part by the MWCC. <br /> Dated �O 2 Z / CITY OF <br /> SIGNATURE r✓� arm <br /> Print Name/: �oAJ1-1 <br /> Title: o <br /> Page 1 of 3 <br /> ZD/92 <br /> Equal Opportunity/Affirmative Action Employer <br />