State Form 43692 - Request For Variance From 326 Iac 4-1 Tree Waste Or Clean Wood Waste Page 2
Download a blank fillable State Form 43692 - Request For Variance From 326 Iac 4-1 Tree Waste Or Clean Wood Waste in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete State Form 43692 - Request For Variance From 326 Iac 4-1 Tree Waste Or Clean Wood Waste with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2(Continued on page 2)
Indiana Department of Environmental Management
Tree waste or clean wood waste
Office of Air Quality
State Form 43692 (R4 / 9-09)
29. Please check the type of structure:
Barn
House
Out building
Church
Garage
Commercial
House trailer
Other (specify):
30. Please check the source of waste:
Road construction
Housing or other building development
Property maintenance
Storm damage
Drift wood from river, stream, or creek
Other (specify):
31. If material to be burned is in a pile, how many piles are there?
32. Each pile is approximately
feet long
feet wide
feet high
(or)
feet diameter
feet high
33. Please check the type of materials mixed in the waste:
None
Painted wood
Treated wood
Insulation
Wiring
PVC pipe
Carpet
Furniture
Appliances
Asphalt roofing
Vinyl or asphalt siding
Other (specify)__________________________________________
PART E: PURPOSE FOR BURNING
34. Please check the purpose of burning:
Recreational
Disposal
PART F: PROJECTED BURNING INFORMATION
35. Projected burning date(s) (mm/dd/yyyy)
36. Total hours of burning time
PART G: ALTERNATE METHODS OF DISPOSAL
37. Approximate cost of disposal
Open burning $_______________ Chipping $_________________ Hauling to an approved landfill $ _____________________
Air curtain destructor $ ______________ Other (specify): ___________________________________$_____________________
38. Reasons, other than costs, why alternative methods of disposal are undesirable:
PART H: SIGNATURE
I hereby certify that the information above is accurate to the best of my knowledge.
_______________________________________________
________________________
Signature
Date: (mm/dd/yyyy)
_______________________________________________
_________________________________________________
Type or print name
Title
Page 2 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
State Form 43692 - Request For Variance From 326 Iac 4-1 - Indiana Department Of Environmental Management
Legal
Form Boe-735 - Request For Relief From Penalty, Collection Cost Recovery Fee, And/or Interest
Financial
Form 5495 - Request For Discharge From Personal Liability Under I.r. Code Sec. 2204 Or 6905
Financial
Form 5495 - Request For Discharge From Personal Liability Under Internal Revenue Code Section 2204 Or 6905 - Information And Instructions
Financial
Form 5495 - Request For Discharge From Personal Liability Under Internal Revenue Code Section 2204 Or 6905
Legal
Form 5495 - Request For Discharge From Personal Liability Under Internal Revenue Code Section 2204 Or 6905
Financial
State Form 30505 - Request For Permission To Destroy Or Transfer Certain Public Records - Indiana Commission On Public Records
Legal
Related Categories
Parent category: Legal