Provide the name and contact information for the organization or individual responsible for this permit. For an organization, also provide the name of the signatory authorized to apply for the permit. The signatory must certify this application. The organization or individual (if there is no organization) becomes the permittee.

Indicate Signatory

If there is a person different than the responsible person above whom MDE should contact with questions or other information regarding this NOI, please provide contact information for that person here. This may be a permits coordinator, project manager, or other such person with direct knowledge of the project.

Indicate the type of organization for the permittee for the project.

Proof of workers’ compensation coverage is required under § 1-202 of the Environment Article. Applicants must provide either worker’s compensation coverage information or a Certificate of Compliance. State and Federal agencies have coverage and do not need to provide this information.

Will you be attaching a Certificate if Compliance with this application? 

You will be required to submit your Certificate if Compliance with this application.