Reset this form
?
(These Buttons Do Not Print)
Application for Permit to Construct a Solid Waste Tire Facility
Bureau of Land and Waste Management
Submit to: Division of Mining and Solid Waste Permitting, Bureau of Land and Waste Management
SC Department of Health and Environmental Control, 2600 Bull Street, Columbia, SC 29201-1708
(Please Print or Type)
I.
Name of project:
Type of Project:
Collection
Processing
Disposal
II.
Physical location (Directions to project - use street names, county road numbers, etc.):
County:
Latitude and longitude (nearest 15 seconds) or UTM coordinates:
III.
In accordance with Title 44, Chapter 96 of the Code of Laws of South Carolina, 1976, as amended, I hereby make
application, on behalf of the party(ies) whose name(s) appears below, for a permit to construct and operate the following
type of solid waste tire facility project (describe):
IV.
Facility's name, mailing address:
Telephone number:
V.
Operator's name, mailing address (if different from name of facility):
Telephone number:
VI.
Landowner's name, mailing address (if different from name of facility or operator):
Telephone number:
VII. I have read this application and all attached documents. I agree to the requirements and conditions that are contained in
it. Also, I agree to the admission of properly authorized persons at all reasonable hours for the purpose of sampling and
inspection.
Name of Facility Representative (print):
Signature:
Facility Representative's title:
Date:
Name of Operator Representative (print):
Signature:
(if different from facility representative)
Operator Representative's title:
Date:
Name of Landowner (print):
Signature:
(if different from facility or operator representative)
Date:
DHEC 3571 (03/1998)
Reset this form
?
(These Buttons Do Not Print)
Reset this form
?
(These Buttons Do Not Print)
Application for Permit to Construct a Solid Waste Tire Facility
Bureau of Land and Waste Management
Submit to: Division of Mining and Solid Waste Permitting, Bureau of Land and Waste Management
SC Department of Health and Environmental Control, 2600 Bull Street, Columbia, SC 29201-1708
(Please Print or Type)
I.
Name of project:
Type of Project:
Collection
Processing
Disposal
II.
Physical location (Directions to project - use street names, county road numbers, etc.):
County:
Latitude and longitude (nearest 15 seconds) or UTM coordinates:
III.
In accordance with Title 44, Chapter 96 of the Code of Laws of South Carolina, 1976, as amended, I hereby make
application, on behalf of the party(ies) whose name(s) appears below, for a permit to construct and operate the following
type of solid waste tire facility project (describe):
IV.
Facility's name, mailing address:
Telephone number:
V.
Operator's name, mailing address (if different from name of facility):
Telephone number:
VI.
Landowner's name, mailing address (if different from name of facility or operator):
Telephone number:
VII. I have read this application and all attached documents. I agree to the requirements and conditions that are contained in
it. Also, I agree to the admission of properly authorized persons at all reasonable hours for the purpose of sampling and
inspection.
Name of Facility Representative (print):
Signature:
Facility Representative's title:
Date:
Name of Operator Representative (print):
Signature:
(if different from facility representative)
Operator Representative's title:
Date:
Name of Landowner (print):
Signature:
(if different from facility or operator representative)
Date:
DHEC 3571 (03/1998)
Reset this form
?
(These Buttons Do Not Print)
ADVERTISEMENT