DSC512013
Canton, GA 30114
P 770-721-7810
www.cherokeega.com
PROJECT
It is in the best interest of property owners and demolition contractors to be knowledgeable of all state and
federal regulations before engaging in any demolition activity. Contact the Georgia Lead Paint and Asbestos
Program at www.gaepd.org/documents/asbnotify.html
for more information or call 404-363-7041.
Structure to be demolished (house, barn, etc.)
Notice: Each owner or operator of a demolition and/or renovation activity must provide the Environmental Protection Division, Lead-
Based Paint and Asbestos Program, with a written notice of their intent. Delivery of the notice must be made by U.S. Postal
Service. The written notice must be on the Asbestos Abatement or Demolition Project Notification form provided by the Division. A
(10) ten working- days notification is required. Notification must be made prior to asbestos stripping, removal or any other activity,
such as site preparation, that would break up, dislodge, or similarly disturb asbestos material, including demolition of buildings.
CONTACT INFORMATION
(please print)
(please print)
AUTHORIZED SIGNATURES
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS
OF ANY OTHER STATE OR LOCAL LAW REGULATING DEMOLITION OR THE PERFORMANCE OF DEMOLITION.
__________________________________________________________________________________
NAME OF CONTRACTOR OR APPLICANT
SIGNATURE ______________________________________________ DATE __________________
This _____ day of ______, 20____.
____________________________________
(Notary Public – Please notarize with official seal)
