Form IL 406-1559 Livestock Waste Lagoon Certification of Construction or Modification - Illinois

Form IL406-1559 or the "Livestock Waste Lagoon Certification Of Construction Or Modification" is a form issued by the Illinois Department of Agriculture.

Download a PDF version of the Form IL406-1559 down below or find it on the Illinois Department of Agriculture Forms website.

ADVERTISEMENT
L
W
L
IVESTOCK
ASTE
AGOON
C
C
M
ERTIFICATION OF
ONSTRUCTION OR
ODIFICATION
A. General Lagoon Location Information:
__________________
__________
__________
____________
County Name
Township #
Range #
Prin. Meridian
_________
____________
____________
Section #
1/4 Section
1/4-1/4 Section
B. Facility Information:
Name:
Mailing Address:
Phone Number:
Facility ID #:
C. Owner or Operator Information:
Name:
Company:
Mailing Address:
Phone Number:
D. Certification Statement:
“I hereby certify that the information provided on this form is correct and that the lagoon has been
constructed in accordance with the standards as required by the Livestock Management Facilities Act
(510 ILCS 77/1 et seq.). Furthermore, I certify that the information included on the originally submitted
registration form, any subsequently submitted amendments, and any information attached to this form is
correct.”
Signature of the Owner or Operator
Page 1 of 1
IMPORTANT NOTICE: This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined under the Livestock Management Facilities
Act (510 ILCS 77). Failure to provide this information shall prevent this form from being processed. This form has been approved by the State Forms Management Center.
IL 406-1559 (1-01)
L
W
L
IVESTOCK
ASTE
AGOON
C
C
M
ERTIFICATION OF
ONSTRUCTION OR
ODIFICATION
A. General Lagoon Location Information:
__________________
__________
__________
____________
County Name
Township #
Range #
Prin. Meridian
_________
____________
____________
Section #
1/4 Section
1/4-1/4 Section
B. Facility Information:
Name:
Mailing Address:
Phone Number:
Facility ID #:
C. Owner or Operator Information:
Name:
Company:
Mailing Address:
Phone Number:
D. Certification Statement:
“I hereby certify that the information provided on this form is correct and that the lagoon has been
constructed in accordance with the standards as required by the Livestock Management Facilities Act
(510 ILCS 77/1 et seq.). Furthermore, I certify that the information included on the originally submitted
registration form, any subsequently submitted amendments, and any information attached to this form is
correct.”
Signature of the Owner or Operator
Page 1 of 1
IMPORTANT NOTICE: This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined under the Livestock Management Facilities
Act (510 ILCS 77). Failure to provide this information shall prevent this form from being processed. This form has been approved by the State Forms Management Center.
IL 406-1559 (1-01)

Download Form IL 406-1559 Livestock Waste Lagoon Certification of Construction or Modification - Illinois

826 times
Rate
4.5(4.5 / 5) 41 votes
ADVERTISEMENT