Kansas Water Pollution Control Permit for Agricultural and Related Wastes
Permit Application
Department Use Only
Facility ID No.
Certification No.
Permit No.
Date Permit Application Complete:
Permit Fee: Yes No
Livestock Waste Management Program
Instructions: PLEASE PRINT. Complete and provide all information as requested. Attach all drawings and plans to this application. If you need assistance completing this form, call (785) 296-6432 or your local KDHE District Office. Mail completed application to:
Livestock Waste Management Section
KDHE - BUREAU OF WATER
1000 SW JACKSON STREET, SUITE 420
TOPEKA, KS 66612-1367 If a registration form has been submitted to KDHE within the previous eighteen months, only pages 1 through 7 and not previously submitted portions of Appendix 3 need to be completed. Any information from pages 5 or 7 submitted with the registration does not need to be resubmitted unless changes need to be noted.
NOTICE: Failure to provide all required documentation at the time of submission of this permit application will result in the entire permit package being returned to the applicant for completion.
