Application for Recycling Permit & Screening Plan Approval



KYTC KEPT #: FORMTEXT ?????SECTION 1: APPLICANT INFORMATIONNAME FORMTEXT ?????BUSINESS NAME FORMTEXT ?????BUSINESS PHONE # FORMTEXT ?????BUSINESS ADDRESS (street) FORMTEXT ?????CITY FORMTEXT ?????STATE FORMTEXT ?????ZIP FORMTEXT ?????EMAIL FORMTEXT ?????CELL PHONE # FORMTEXT ?????SECTION 2: LOCATION INFORMATION Please check one: FORMCHECKBOX State Highway FORMCHECKBOX County Road FORMCHECKBOX City Street FORMCHECKBOX Private RoadROAD NAME FORMTEXT ?????COUNTY FORMTEXT ?????ROUTE # FORMTEXT ?????MILE POINT FORMTEXT ?????LONGITUDE (X) FORMTEXT ?????LATITUDE (Y) FORMTEXT ?????1.If location is an automobile, vehicle, or machinery recycling establishment, does it contain a combined total of five (5) or more junked, wrecked, or non-operative automobiles, vehicles, or machines? FORMCHECKBOX Yes FORMCHECKBOX No2.If location is an automotive dealer, body shop operator, wrecker service operator, or service station operator, does it contain ten (10) or more junked, wrecked, or non-operative automobiles, vehicles, or machines? FORMCHECKBOX Yes FORMCHECKBOX No3.If location is a material recycling establishment, describe materials: FORMTEXT ?????4.Does the County or City have zoning regulations? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, is the location of the recycling storage area within a legally zoned area? FORMCHECKBOX Yes FORMCHECKBOX No5.Is the recycling storage area presently screened from view of the traveling motorist on a year-round basis? FORMCHECKBOX Yes FORMCHECKBOX NoIf no, describe proposed screening in detail, including materials to be used for screening, height, length, color, etc.(Attach screening plan drawing.) FORMTEXT ?????SECTION 3: APPLICANT SIGNATURESI certify that the above statements are correct to the best of my knowledge.APPLICANT DATENote: An automotive recycling dealer license is required by law and available at the address below:Motor Vehicle Commission200 Mero Street, 3rd Floor WestFrankfort, KY 40622 ONEDISTRICT TWODISTRICT THREEDISTRICT FOUR5501 Kentucky Dam Road1840 North Main Street900 Morgantown Road634 East Dixie HighwayPaducah, KY 42003Madisonville, KY 42431Bowling Green, KY 42101Elizabethtown, KY 42701(270) 898-2431(270) 824-7080(270) 746-7898(270) 766-5066BallardCaldwellAllenBreckinridgeCallowayChristianBarrenGraysonCarlisleDaviessButlerGreenCrittendenHancockEdmonsonHardinFultonHendersonLoganHartGravesHopkinsMetcalfeLaRueHickmanMcLeanMonroeMarionLivingstonMuhlenbergSimpsonMeadeLyonOhioToddNelsonMcCrackenUnionWarrenTaylorMarshallWebsterWashingtonTriggDISTRICT FIVEDISTRICT SIXDISTRICT SEVENDISTRICT EIGHT8310 Westport Road421 Buttermilk Pike800 Newtown Court1660 S. Highway 27Louisville, KY 40242Covington, KY 41017Lexington, KY 40511Somerset, KY. 42502(502) 210-5400(859) 341-2700(859) 246-2355(606) 677-4017BullittBooneAndersonAdairFranklinBrackenBourbonCaseyHenryCampbellBoyleClintonJeffersonCarrollClarkCumberlandOldhamGallatinFayetteLincolnShelbyGrantGarrardMcCrearySpencerHarrisonJessaminePulaskiTrimbleKentonMadisonRockcastleOwenMercerRussellPendletonMontgomeryWayneRobertsonScottWoodfordDISTRICT NINEDISTRICT TENDISTRICT ELEVENDISTRICT TWELVE822 Elizaville Avenue473 Highway 15 South603 Railroad Avenue109 Lorraine StreetFlemingsburg, KY 41041Jackson, KY 41339Manchester, KY 40962Pikeville, KY 41501(606) 845-2551(606) 666-8841(606) 598-2145(606) 433-7791BathBreathittBellFloydBoydEstillClayJohnsonCarterLeeHarlanKnottElliottMagoffinJacksonLawrenceFlemingMenifeeKnoxLetcherGreenupMorganLaurelMartinLewisOwsleyLesliePikeMasonPerryWhitleyNicholasPowellRowanWolfe ................
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