Required fields are marked with asterisks (*)

Application for a Hauled Sewage Discharge Permit

This application must be completed and submitted to the Corporation of Haldimand County’s Environmental Services Division for review before hauling and discharging waste to a Haldimand County facility. Completion of this application is an annual requirement.

Applicant Information

Company/Business name

Owner's name

Company/Business mailing address

Address

Town/City

Province

Postal code

Name of company contact/business contact

Phone number

Fax number

Cell number

Emergency Contact Information

In the event of an emergency, the following person will be contacted by Haldimand County. Please leave blank if same as above.

Name of emergency contact

Phone number