Form IL406-1605 "Livestock Waste Lagoon Liner Certification of Construction or Modification" - Illinois

What Is Form IL406-1605?

This is a legal form that was released by the Illinois Department of Agriculture - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2001;
  • The latest edition provided by the Illinois Department of Agriculture;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form IL406-1605 by clicking the link below or browse more documents and templates provided by the Illinois Department of Agriculture.

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Download Form IL406-1605 "Livestock Waste Lagoon Liner Certification of Construction or Modification" - Illinois

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L
W
L
L
IVESTOCK
ASTE
AGOON
INER
C
C
M
ERTIFICATION OF
ONSTRUCTION OR
ODIFICATION
A. General Lagoon Location Information
:
(please provide the following information)
__________________
__________
__________
____________
County Name
Township #
Range #
Prin. Meridian
_________
____________
____________
Section #
1/4 Section
1/4-1/4 Section
B. Facility Information:
Name:
Mailing Address:
Phone Number:
C. Owner or Operator Information:
Name:
Company:
Mailing Address:
Phone Number:
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 406-1605 (1-01)
L
W
L
L
IVESTOCK
ASTE
AGOON
INER
C
C
M
ERTIFICATION OF
ONSTRUCTION OR
ODIFICATION
A. General Lagoon Location Information
:
(please provide the following information)
__________________
__________
__________
____________
County Name
Township #
Range #
Prin. Meridian
_________
____________
____________
Section #
1/4 Section
1/4-1/4 Section
B. Facility Information:
Name:
Mailing Address:
Phone Number:
C. Owner or Operator Information:
Name:
Company:
Mailing Address:
Phone Number:
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 406-1605 (1-01)
D. Certification Statement (
:
please provide a signature and stamp/seal)
“I hereby certify that the livestock waste liner herein described meets all the applicable
requirements of the Livestock Management Facilities Act (510 ILCS 77/1 et seq.) and the
rules promulgated thereunder.”
Registered Professional Engineer’s Signature
Stamp / Seal
Engineer’s Name: _______________________________________________________________
Company Name:________________________________________________________________
Address: _ ______________________________________________________________________
City / State / Zip code: ___________________________________________________________
Telephone:_______________________
Fax: _______________________
E. Supporting Justification and Data:
Pursuant to 8 Ill. Adm. Code 900.605(a), supporting justification and data relative to the construction or
installation of the liner is required as part of the engineer’s certification.
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