Application for Waste Disposal

Application for Waste Disposal Investigation and Remediation Permit

Pwner of Property
Mailing Address
Engineering Firm/Contractor
Mailing Address

By affixing my signature below, I certify that the proposed work will be conducted in a manner that conforms to all applicable laws including all sections of Chapter 26 of the Revised Code of Ordinances for the City of Murphysboro as well as all other State and Federal laws that may be applicable to this project.

MM slash DD slash YYYY
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Validation

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Cash _________ Check # _________
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