DANC - Development Authority of the North Country - Application for Reduced Tip Fee Programs

Development Authority of the North Country

Application for Reduced Tip Fee Programs

Application for municipalities and local governments to request a 25% reduced tip fee at the Development Authority of the North Country Materials Management Facility under either the Community Improvement Program or Residential Cleanup Program.

*Program Type

Community Improvement Program (CIP) – 25% off published gate rate, for municipal construction & demolition projects

Residential Clean-up Program (RCP) – 25% off published gate rate, for municipally sponsored semi-annual clean-up days

Select the program you are applying for.

*Project description and/or justification for a reduced tip fee

Requestor Information

*Name of Local Government or County Official

*Title

*Municipality / Agency Name

*Address

*City, State, Zip

*Email Address

*Phone

Project Information

*Site Name

*Site Address

*City, State, Zip, County

*Waste Type to be Disposed

*Amount (Tons)

*Project Date / Time Frame

*Is property owned by the municipality or non-profit agency?

Yes

*Are municipal / non-profit agency funds paying for the project?

Yes

*How is waste being transported?

Through a county transfer station (billed through county)

Direct to landfill by municipality

Direct to landfill by private hauler

Select all that apply.

Hauler Information

The hauler must have a current Authority-issued permit. For waste through a county transfer station, list the county as hauler.

*Hauler Contact Name

Hauler Contact Title

*Hauler Company Name

*Hauler Address

*Hauler City, State, Zip, County

*Hauler Phone

Hauler Fax

*Hauler SWMF Permit #

The hauler must have a current Authority-issued permit.

Hauler Email Address

Contractor Information (If Applicable)

Not applicable for Residential Cleanup Program. For Community Improvement Program, provide information on the company performing construction, demolition, or excavation work.

Contractor Contact Name

Contractor Contact Title

Contractor Company Name

Contractor Address

Contractor City, State, Zip, County

Contractor Phone

Contractor Fax

Contractor Email

Billing Information

Indicate whether the municipality/non-profit or the hauler should be billed.

*Billing Company Name

*Billing Address

*Billing City, State, Zip

Billing SWMF Permit / Account #

*County or Local Government Official Signature

Type your full name to confirm:

By signing, you create a contractual obligation between the parties for acceptance of waste and payment for disposal in accordance with the Authority's regulations.

*Signature Date

Approvals: Authority Use Only

The fields below are for Authority staff use only.

Materials Management Division Director Signature

Type your full name to confirm:

Authority Approval Date

Division Director Printed Name

Division Director Title

SWMF Special Waste # (for CIP)

Waste Class ID #

RCP # or CIP #

Tip Fee Rate / Ton Approved

Confirm

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