Free 47215.pdf - Indiana

SOLID WASTE FACILITY PERMIT APPLICATION & REGISTRATION FEE TRANSMITTAL
State Form 47215 (R4 / 8-05)

Indiana Department of Environmental Management Approved by State Board of Accounts, 2005 INSTRUCTIONS

INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Cashiers Office 100 N. Senate Avenue Indianapolis, IN 46204

This form shall be used to transmit fees for all solid waste management facility permits, applications (NEW permits, RENEWALS of permits, MAJOR and MINOR MODIFICATIONS of permits) and registrations. The current fee schedule was established by Indiana Code § 13-20-21-2 through 13-20-21-3, and is to accompany all payments. Make check or money order payable to the Indiana Department of Environmental Management. Upon completion, return this form and appropriate fees to the address given in the box above. A COPY of your check and a COPY of this fee transmittal form must be attached to your permit application or registration when it is separately submitted to the Office of Land Quality, Solid Waste Permits Section.

Section A. Applicant(s) Information
Name Mailing Address: State Facility Name and County Street ZIP Code Apt. # P.O. Box Town/City

Telephone Number (with area code)

Section B. Solid Waste Permit Fee Schedule
The following fees are to accompany applications and registrations. Permit Application for New Sites and Major Modifications Permit Applications Sanitary Landfill (including MSWLFs and non-MSWLFs) Processing Facility Transfer Station Other Processing Incinerators Restricted Waste Site Type I Restricted Waste Site Type II Restricted Waste Site Type III Construction/Demolition Site Registrations Waste Tire Storage Waste Tire Processing (cutting, shredding, etc. Waste Tire Transportation $500 $200 $25 $200 $12,150 $12,150 $28,650 $31,300 $31,300 $20,000 $20,000 $2,200 $2,200 $5,900 $15,350 $15,350 $7,150 $7,150 $2,500 $2,500 $2,500 $2,500 $2,500 $2,500 $2,500 $31,300 $15,350 $2,500 Renewal Minor Modifications

2830-412000-100700