Kansaswater Pollution Control Permit Foragricultural Andrelated Wastes Permit Application (Page 9 of 10) in pdf

Kansaswater Pollution Control Permit Foragricultural Andrelated Wastes Permit Application Page 9

APPENDIX 2a

Habitable Structure/Property Owners List

(For proposed new construction or expansion of an existing facility)

Using the format provided, please record the name, address, city, state, zip code of the owner, distance from the facility,

and direction from the facility, of all property owners and habitable structures within 1 mile of the facility

Habitable structures means any of the following structures which is occupied or maintained in a condition which may be

occupied and which, in the case of a confined feeding facility for swine, is owned by a person other than the operator of

such facility: a dwelling, church, school, adult care home, medical care service, child care facility, library, community

center, public building, office building, or licensed food service, or lodging establishment, parks, and wildlife refuge.

Name

Mailing Address (address, city, state, zip)

Distance*

Direction

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

* As measured from the currently planned maximum extent of the facility structures such as buildings or wastewater lagoons.

New and expanding swine facilities with 1,000 or more AU of swine should also provide this information for habitable structures

within 1,000 feet of any land application area.

KDHE BOW LWMS Permit Application form rev 4/7/2015

Page 9 of 10

Kansaswater Pollution Control Permit Foragricultural Andrelated Wastes Permit Application Page 9