Temporary Labor Community Permit Application

Temporary Labor Community Permit Application
For more information, please refer to Rule: R392-501
Contact Person*

First NameLast Name
Contact Person's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date*

MonthDayYear
Date
Parcel Number*
Facility Name:*
Facility Address (physical and mailing)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Facility Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com

Upload the following
Proof of drinking water source (If hauled, a copy of the contract with a permitted Commercial Water Hauler must be submitted.)*

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Proof of wastewater disposal (Onsite wastewater system or temporary sewage holding tank. If holding tanks are used, a copy of the contract with a permitted LIquid Waste Operator for service must be submitted. Holding tanks must meet rule requirements.*)*

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Food Service operating permit from TriCounty Health Department (if applicable*).

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Company information for solid waste disposal.

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*ADDITIONAL APPLICATIONS AND FEES MAY BE REQUIRED BASED ON SERVICES PROVIDED BY YOUR FACILITY.

THE FACILITY MUST HAVE A PRE-OPENING INSPECTION PERFORMED BY TRICOUNTY HEALTH PRIOR TO USE.

Fee*

Inspection/Permit Fee

$700.00

Total

$0.00