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2. 
3. Solid Waste Facility License Application
5. Solid Waste Facility Licenses are required pursuant to Chisago County Solid Waste Ordinance No. 08-2 Article VI - Facility Requirements, Section 1 - Facility Licenses Required.
7. Date:
   Date:
8. Chisago County Solid Waste Ordinance No. 08-2
   Chisago County Solid Waste Ordinance No. 08-2
10. 1. The Individual Solid Waste Facilities Licenses I am applying for are as follows (check all that apply)*

    1. Construction and Demolition Debris Land Disposal Facility
    2. Industrial Solid Waste Land Disposal Facility
    3. Mixed Municipal Solid Waste Land Disposal Facility
    4. Recycling Facility
    5. Solid Waste Processing Facility
    6. Transfer Station Facility
    7. Waste Tire Facility
    8. Yard Waste and Composting Facility
12. 2. APPLICANT INFORMATION:
14. Name of Owner or Operator Applicant:*
16. Title:*
18. Name of firm:*
20. Address1:*
22. Address2:
24. City*
25. State*
26. Zip*
28. Phone Number*
29. Cell Number
31. Email*
32. Website:
34. 3. Facility Locations (street address & Legal description):*
36. 4. General property description and location size:*
38. 5. Description of property in vicinity & current zoning:*
40. 6. Landowner (if different than Applicant, must submit the Landowner Acknowledgement Form):*
42. 7. Specifications of operation (general statement of business operation, and plan):*
44. 7a. Upload a file with any additional relevant information:
45. 7b. Upload File:
47. 8. Type, quantity, source of materials accepted (itemize and be specific):*
49. 8a. Upload a file with any additional relevant information:
50. 8b. Upload File:
52. 9. Reference here any additional data or information you feel relevant, or as required by the SWA:
54. 10. COUNTY FACILITY LOCATION:
56. Is a Conditional Use Permit (CUP) or other special zoning or land use regulation or permit required to operate this Solid Waste Facility in Chisago County?

    1. Yes, If YES, the applicant is required to obtain a sign-off from the local land use authority (i.e. City of County) and submit the separate Local Zoning Sign-Off Form.
    2. No
58. **Identification of non-compliant zoning or land use permit conditions may be cause for Conditional License status or license denial.
60. 11. Specific facility license requirements may apply (please check ALL Solid Waste License Facilities applied for):

    1. Recycling Facility Application
    2. Transfer Station Application
    3. Yard Waste and Composting Facility Application
62. 11a. RECYCLING FACILITY APPLICATIONS - Must upload a copy of EPA Technicians Certificate for CFC Removal if facility is recovering refrigerants.
63. Upload EPA Technicians Certificate
65. 11b. TRANSFER STATION APPLICATIONS - must detail ultimate destination of accepted waste:
67. 11c. YARDWASTE AND COMPOSTING FACILITY APPLICATIONS - must describe process used in detail:
69. 12. The licensee shall demonstrate to the County the availability of revenues necessary to operate the facility in accordance with all applicable state and local laws, ordinances and rules.
71. 13. The licensee shall furnish to the County certificates of insurance issued by insurers duly licensed within the State of Minnesota covering public liability insurance, including general liability, automobile liability, loading and unloading, completed operations liability, bodily injury liability in an amount of at least $1,000,000 for injury or death of any one person in any one occurrence and aggregate bodily liability in an amount of at least $2,000,000 for injuries or death arising out of any occurrence. Property damage liability shall be furnished in an amount of at least $1,000,000 for any one occurrence and in the unencumbered aggregate amount of at least $2,000,000.
73. 14. Facility licenses shall furnish the required amount of Financial Assurance to the Department.
75. 15. The fee for each Individual Solid Waste Facility License checked off on the list above is (for example: if you have checked off Recycling, and Transfer, you owe $500). . . . . . . . . . . . . . . $250.00 per License.
77. Number of Facility Licenses*
78. Number of Facility Licenses multiplied by $250 each =
79. TOTAL Facility Licenses Fees*
81. ***Please write a check payable to Chisago County and mail to 39649 Grand Avenue, North Branch, MN 55056, -OR- Pay Online via debit/credit or e-Check by using the link below:
    Online Payment Link
83. Licensee agrees to faithfully perform and comply with the Chisago County Solid Waste Ordinance, Ordinance No. 08-2. This license may be revoked or refused by Chisago County for cause. Any activities in violation of the Chisago County Solid Waste Ordinance, Ordinance No. 08-2 or refusal on the part of a licensee to abandon such activities shall be cause for revocation of or refusal to renew a license and forfeiture of bond.
85. Signed by:*
    Licensee - Upload file with your signature.
86. Date Signed:*
    Date Signed:
88. Approved by: _______________________________________________________
    Chisago County Solid Waste Administrator
89. Date: ____________________
Leave This Blank:


91. Submit Submit and Print

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