Form 4400-088 "Solid Waste Facility Initial License Application" - Wisconsin

What Is Form 4400-088?

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

Form Details:

  • Released on September 1, 2012;
  • The latest edition provided by the Wisconsin Department of Natural Resources;
  • 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 4400-088 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Natural Resources.

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Download Form 4400-088 "Solid Waste Facility Initial License Application" - Wisconsin

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State of Wisconsin
Solid Waste Facility Initial License
Department of Natural Resources
Application
PO Box 7921, Madison WI 53707-7921
Form 4400-088 (R 9/12)
Page 1 of 2
dnr.wi.gov
Notice: Applicants are required to complete a separate application to
Leave Blank - DNR Use Only
obtain a license to operate each solid waste facility, under the
Date Received
Exp. Year
Check No.
Check Amt.
provisions of s. 289.31, Wis. Stats. Failure to submit complete
information as requested on this form shall be grounds for denial of the
application. Personal information collected will be used for
License No.
FID No.
Date License Issued
Completed By
management of DNR programs. Wisconsin's Open Records law
requires the Department to provide this information upon request
[ss. 19.31 - 19.69, Wis. Stats.].
Read instructions on reverse side before completing this form.
Facility Information
1. Name of Facility
2. Name of Property Owner
3. Property Owner is (county, city, private, federal, tribal, etc.)
4. Name of Licensee (Facility Operator)
5. Licensee is (county, city, private, federal tribal, etc.)
6. Contact Person
7. Title
8. Street, Route or Box (mailing address)
9. Telephone Number of Contact Person (include area code)
Ext.
10. City
State 11. ZIP Code
12. E-mail Address
13. Type of Facility (number codes are for Department tracking): (check the appropriate box)
Woodburning Facility (001)
SW Yard Residuals Composting < 20,000 cu yd (103)
Storage Facility (010)
SW Yard Residuals Composting > 20,000 cu yd (104)
Processing Facility (040)
Transfer Facility <100 ton/day (030)
SW Source Separated Compostable Material Composting
Transfer Facility >100 ton/day (035)
< 5,000 cu yd (105)
Other
SW Source Separated Compostable Material Composting
> 5,000 cu yd (106)
14.
County
Range
¼ / ¼
¼
Section
Township
# of Licensed Acres
E
Facility
W
Location
N
Address
Township
Approved Waste Types (check all that apply)
Bark/Brush (W070)
Fly Ash (W280)
Source-Separated Compostable Materials (W745)
Refuse (W670)
Tires (W770)
Infectious Waste (W420)
Other:
Garbage (W340)
Yard Waste (W800)
Paper Mill Sludge (W580)
Other:
Demolition (W220)
Foundry (W290)
Contaminated Soil (W180)
Other:
Service Area (list counties or check the statewide box)
Statewide
1.
2.
3.
4.
5.
6.
7.
8.
State of Wisconsin
Solid Waste Facility Initial License
Department of Natural Resources
Application
PO Box 7921, Madison WI 53707-7921
Form 4400-088 (R 9/12)
Page 1 of 2
dnr.wi.gov
Notice: Applicants are required to complete a separate application to
Leave Blank - DNR Use Only
obtain a license to operate each solid waste facility, under the
Date Received
Exp. Year
Check No.
Check Amt.
provisions of s. 289.31, Wis. Stats. Failure to submit complete
information as requested on this form shall be grounds for denial of the
application. Personal information collected will be used for
License No.
FID No.
Date License Issued
Completed By
management of DNR programs. Wisconsin's Open Records law
requires the Department to provide this information upon request
[ss. 19.31 - 19.69, Wis. Stats.].
Read instructions on reverse side before completing this form.
Facility Information
1. Name of Facility
2. Name of Property Owner
3. Property Owner is (county, city, private, federal, tribal, etc.)
4. Name of Licensee (Facility Operator)
5. Licensee is (county, city, private, federal tribal, etc.)
6. Contact Person
7. Title
8. Street, Route or Box (mailing address)
9. Telephone Number of Contact Person (include area code)
Ext.
10. City
State 11. ZIP Code
12. E-mail Address
13. Type of Facility (number codes are for Department tracking): (check the appropriate box)
Woodburning Facility (001)
SW Yard Residuals Composting < 20,000 cu yd (103)
Storage Facility (010)
SW Yard Residuals Composting > 20,000 cu yd (104)
Processing Facility (040)
Transfer Facility <100 ton/day (030)
SW Source Separated Compostable Material Composting
Transfer Facility >100 ton/day (035)
< 5,000 cu yd (105)
Other
SW Source Separated Compostable Material Composting
> 5,000 cu yd (106)
14.
County
Range
¼ / ¼
¼
Section
Township
# of Licensed Acres
E
Facility
W
Location
N
Address
Township
Approved Waste Types (check all that apply)
Bark/Brush (W070)
Fly Ash (W280)
Source-Separated Compostable Materials (W745)
Refuse (W670)
Tires (W770)
Infectious Waste (W420)
Other:
Garbage (W340)
Yard Waste (W800)
Paper Mill Sludge (W580)
Other:
Demolition (W220)
Foundry (W290)
Contaminated Soil (W180)
Other:
Service Area (list counties or check the statewide box)
Statewide
1.
2.
3.
4.
5.
6.
7.
8.
Solid Waste Facility Initial License
Application
Form 4400-088 (R 9/12)
Page 2 of 2
Landfills and Other Facilities
15. Landfills and Other Facilities to which waste is taken (include DNR license number if known):
Name
Location (City and State)
DNR License Number
1.
2.
3.
16. Collection and Transportation Services Using Facility:
1.
2.
3.
Certification
I hereby certify that the information and attachments provided are true and complete.
Print Name
Signature of Authorized Contact Person
Title
Date Signed
Instructions for Completing This Form
1. This form is to be used for initial licensing of Solid Waste Facilities except for solid waste landfills and transporters.
Applicants for landfill licenses should use Form 4400-19, Landfill License Application, and applicants for solid waste
transportation licenses should use Form 4400-179, Transportation License Application for Solid Waste Transporters.
2. Submit this application form, with the appropriate license fee, after you have received the plan of operation approval
for your facility. See ch. NR 520, Wis. Adm. Code and Table 2 for more information.
3. All items may not apply to all types of facilities. Items that do apply must be completed, items that do not apply should
be marked with "N/A".
4. Sign and date the form. Signature must be that of the authorized contact person: facility owner, corporation officer,
municipal or county official, etc.
5. Your check or money order, payable to the Department of Natural Resources, must be attached. Please mail to the
appropriate DNR regional office. Do not send to the Department office in Madison.
6. Any questions concerning solid waste licensing, or the completion of this form, should be directed to the Waste
Management Specialist at your local DNR regional office.
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