St. Louis County Environmental Services Department
License Renewal Application for the Operation of a
Solid Waste Management Facility
***Please Type or Print Legibly***
By submitting this application I agree to allow free access to authorized representatives of St. Louis
County for the purpose of conducting routine inspections of this facility and/or records to insure
consistent compliance with Ordinance 45.
I. Checklist of required information:
At a minimum, the following information will be required to be submitted, along with this
application form before review of the license application will be completed:
unless previously sent a complete copy of the facility annual report as submitted to
the MPCA including a set of complete survey drawing; and
the name, address and phone number(s) of industrial waste customers; and
a filing fee of $700.00 as established by the St. Louis County Board, made payable to
the St. Louis County Auditor; and
a copy of the certificate of insurance for the facility including Worker’s Compensation
coverage; and
a bond in the amount of $__________.
Issuance of any license pursuant to the provisions of this Ordinance shall be contingent upon the applicant
furnishing to the County a bond in an amount and manner to be determined by the Environmental Services
Director. This bond shall name the County as obligee with sufficient sureties duly licensed and authorized to
transact business in the State of Minnesota. The condition of such bond shall be that if the Licensee fails to
comply with any of the requirements or fails to perform any of the acts required of a Solid Waste operation or
ceases to operate or abandons the operation, and the County is required to expend monies, any labor or
material to restore the Site to a condition in compliance with St. Louis County Ordinance 45, the bond holder
and the sureties on its bond shall reimburse the County for any and all the expenses incurred by the County
to remedy failure of the Licensee to comply with the terms of that Ordinance. The bond holder and its
sureties shall indemnify and save the County harmless from all losses, costs, and charges that may occur to
the bond holder or its sureties because of any default of the Licensee under the terms of this license to
operate in compliance with the terms of the Ordinances of St. Louis County and the statutes of the State of
Minnesota.
Name of Facility MPCA Permit No.
Name Date
Signature
Title & Department
Organization
Address
City State Zip Code
Applicant
(Permitee
Activity Owner)
Phone Fax
