25I-LCID- Cieszko LCID SW021-0096 PARF & Invoice 08-03-2021

PERMIT APPLICATION REVIEW FORM
Review Requested by: Diana Felix
Date Requested: 8/3/2021
Facility Name and Permit ID Cieszko LCID, 25I-LCID
Applicant (Owner) Name Martin Cieszko
Description of Permit Request
[This is the action the applicant
is requesting in accordance with
NCGS 130A-294(a3)]
(1)a. New – New Facility
(1)b. New – Substantial Amendment
(1)c. New – Expand Waste Boundary
(1)d. New – Waste Category Change
(1)e. New – Permit Less than LoS Duration
(2)a. Amendment – Renewal/Review
(2)b. Amendment – Change in Ownership
(3)a. Modification – Change to Approved Plans (No CHR)
(3)b. Modification – Five-year Limited Review (No CHR)
Permitted Annual Tonnage
Permit Fee (New Only)
Date Application Received 4/20/2021
Contact Name & Title Martin Cieszko, Owner
Phone # [phone]
Email Address [e-mail]
Company Cieszko Construction Company, Inc.
911 Address 1090 NC Hwy 101
Mailing Address PO Box 690
City/State/Zip Havelock, North Carolina 28532
Parent Company unknown
Known Subsidiaries
Other known names business
has operated under
Known Counties of Operation Craven
Does the applicant have a past
or current solid waste permit?
Yes No Unknown
Facility Type: Permit #: 25I-LCID
Did the permit applicant submit
Financial Assurance cost
estimates?
Yes No Not Needed
Other notes