Section II Permittee (Applicant) Identification: – Name of business, company, municipality, etc. requesting the permit: 1. 2. Street address/P.O. Box: City: State: Zip: County: 3. 4. 5. 6. Contact person: 7. 8. Title: 9. Phone Number: Email: 10. Section III Treatment Facility Location & Contact Information: – 1. Treatment facility physical location: a. Facility name: Street address: County: b. c City: State: d. e. Zip: f. g. Latitude-Longitude (in decimal degrees): 2. Treatment facility contact & mailing address: Same as in Section II above a. Contact person: b. Title: Organization: c. Phone number: d. e. Email: Street address/P.O. Box: f. City: State: Zip: g. h. i.
Section II – Permittee (Applicant) Identification: 1. Name of business, company, municipality, etc. requesting the permit: 2. Street address/P.O. Box: 3. City: 4. State: 5. Zip: 6. County: 7. Contact person: 8. Title: 9. Phone Number: 10. Email: Section III – Treatment Facility Location & Contact Information: 1. Treatment facility physical location: a. Facility name: b. Street address: c County: d. City: e. State: f. Zip: g. Latitude-Longitude (in decimal degrees): 2. Treatment facility contact & mailing address: Same as in Section II above a. Contact person: b. Title: c. Organization: d. Phone number: e. Email: f. Street address/P.O. Box: g. City: h. State: i. Zip: