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STATEWIDE SANITARY SEWER SYSTEMS GENERAL ORDER 2022-0103-DWQ <br /> <br />5.Billing Information <br />Billing Address: ___________________________________________________________ <br />City, State, Zip: ___________________________________________________________ <br />Billing Contact Person and Title: ______________________________________________ <br />Phone and Email Address: __________________________________________________ <br />6. Application Fee: <br />The application fee, as required by Water Code section 13260, is based on the daily <br />population served by the sanitary sewer system. See updated Fee Schedule. <br />(https://www.waterboards.ca.gov/resources/fees/water_quality/) <br />Check one of the following and enter fee amount: <br /> Population Served < 50,000 Total Fee submitted: $ ___________ <br /> Population Served Total Fee submitted: $ ___________ <br />Make the fee payment payable to the State Water Resources Control Board and mail the <br />complete application package to: <br />State Water Resources Control Board, Accounting Office <br />P. O. Box 1888 <br />Sacramento, CA 95812-1888 <br />Attention: Statewide Sanitary Sewer System Program <br />7. Application Submittal Certification <br />I certify under penalty of perjury under the laws of the State of California that to the best of <br />my knowledge and belief, the information in the submitted application package is true, <br />accurate and complete. I am aware that there are significant penalties for submitting false <br />information, including the possibility of fines and imprisonment. <br />Print Name: ______________________________________________________________ <br />Title: ___________________________________________________________________ <br />Signature: __________________________________________ Date: ________________ <br /> <br />ATTACHMENT B APPLICATION FOR ENROLLMENT December 6, 2022 <br />B - 2 <br /> <br />