0db72db9370f4d8db7c8677aca4f467c

March 18, 2019 | Author: Anonymous | Category: N/A
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REQUEST FOR VARIANCE FROM CHAPTER 511 OF THE INDIANAPOLISAIR POLLUTION CONTROL ORDINANCE Upon review of the guidelines, please complete the following and return to the City of Indianapolis Bureau of Environmental Services, 1200 Madison Avenue, Suite 100, Indianapolis, Indiana 46225 (or FAX 317-327-2274), 20 days prior to the proposed burning date. A complete list of names and addresses of all the parties within 500 feet of the burning site and any other interested persons should accompany the application. Property Owner Requesting Variance: Name: Phone Number:

Fax:

E-mail:

Mailing Address: City:

State:

Zipcode:

Site Location: Address: City:

Township: State:

Zipcode:

Project Burning Date & Time: (Must be between 10:00a.m. and 7:00p.m.) Alternative Date and Time: Size of Pile: Type of Material: If fence row, type of fence (wood, metal, etc.): Distance to nearest structure(s) or combustible material (30 ft. minimum required): Type of Extinguishment: State reason why alternative methods of disposal would not be feasible:

Please refer to the attached for other restrictions. If you have any questions, please call the City of Indianapolis Bureau of Environmental Services at (317) 327-3297. Rev. 10/17 Department of Business and Neighborhood Services 1200 Madison Ave., Ste. 100 │Indianapolis, IN 46225│Phone: (317) 327-8700 │www.indy.gov/bns Fax Numbers: Building - 327-8475 │Business Licensing - 327-0817│Contractor Licensing – 327-8401 Crafts - 327-5397│Infrastructure/Right of Way - 327-3125│Permits - 327-5174│Zoning - 327-8696

IDENTIFICATION OF POTENTIALLY AFFECTED PERSONS 1.

Name: Address: City:

2.

State:

Zipcode:

State:

Zipcode:

State:

Zipcode:

State:

Zipcode:

State:

Zipcode:

State:

Zipcode:

State:

Zipcode:

Name: Address: City:

3.

Name: Address: City:

4.

Name: Address: City:

5.

Name: Address: City:

6.

Name: Address: City:

7.

Name: Address: City:

ADDRESS OF SITE: Street: City: Signature: Date:

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