Send completed application to: County: ______________________ Environmental Protection Division, Waste Management Program Facility Name: 4244 International Parkway, Suite 104 Atlanta, GA 30354-3902 _____________________________ CCR Unit - Application for Solid Waste Handling Permit (Please type or print) I. Owner’s Name or Registered Corporation Name: Facility Address: Phone: City: State: ZIP Code: Authorized Official: Mailing Address: City: ZIP Code: Address: Facility CCR Website(s): II. PROPERTY DETAILS: Complete below and attach a street or highway map indicating the site/facility location. Application must be accompanied by written zoning confirmation. County: City: Co-ordinates (in decimal degrees, near facility center): Property for Processing/Disposal is: Owned Leased (please complete owner details below) ☐ ☐ Property Owner (if leased): Address: Phone: City: State: Zip: III. APPLICATION TYPE: New Permit Major Modification to Existing Permit Transfer of Permit ☐ Other ☐ IV. CCR UNITS: List all CCR units covered under this application V. 5% O.C.G.A.
Send completed application to: Environmental Protection Division, Waste Management Program 4244 International Parkway, Suite 104 Atlanta, GA 30354-3902 County: ______________________ Facility Name: _____________________________ CCR Unit - Application for Solid Waste Handling Permit (Please type or print) I. Owner’s Name or Registered Corporation Name: Facility Address: Phone: City: State: ZIP Code: Authorized Official: Mailing Address: City: ZIP Code: Address: Facility CCR Website(s): II. PROPERTY DETAILS: Complete below and attach a street or highway map indicating the site/facility location. Application must be accompanied by written zoning confirmation. County: City: Co-ordinates (in decimal degrees, near facility center): Property for Processing/Disposal is: ☐ Owned ☐ Leased (please complete owner details below) Property Owner (if leased): Address: Phone: City: State: Zip: III. APPLICATION TYPE: ☐ New Permit Major Modification to Existing Permit Transfer of Permit ☐ Other IV. CCR UNITS: List all CCR units covered under this application V. 5% O.C.G.A.
CCR_Unit_Application_Solid_Waste_Handling_Permit_091418.docx