DEPARTMENT OF ENVIRONMENTAL QUALITY
UNIFORM PERMITTING
NOTICE TO LANDOWNER, REQUIREMENTS AND AFFIDAVIT
Dear Applicant:
If your application involves land and you don't own all of the land that is the subject of your
Tier I, II or III permit application, you must notify the owner(s). [See Title 27A of the
Oklahoma Statutes, §2-14-101, et seq.]
Rule OAC 252:4-7-13(b):
Applicants shall certify by affidavit that they own the real property, have a current lease or
easement which is given to accomplish the permitted purpose or have provided legal notice to the
landowner.
If the landowner notice applies to your application, you can use the form at the bottom of this
page as your notice.
Please note that you MUST fill out and return the Affidavit on page 2 even if you don't have
to give any landowner notice.
Any questions? Please call the DEQ program which is processing your permit.
Thank you from the DEQ.
NOTICE TO LANDOWNER OF FILING
Dear Landowner: (Name)________________________________________:
(Applicant Name) ____________________ has filed an application with the Department
of Environmental Quality for the following permit/certification/registration,
_____________________________________, for (Name))__________________________
facility.
This application involves the land owned by you located at:
Address (Street/City):
Legal Description
Signed:
Date_________________
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DEPARTMENT OF ENVIRONMENTAL QUALITY
AFFIDAVIT ABOUT NOTICE TO LANDOWNER*
I, as the applicant or an authorized representative of the applicant, hereby certify that notice
to the landowner(s) about the application described below:
__________IS NOT REQUIRED because:
_______ My application does not involve any land.
_______ My application involves only land owned by me (or the applicant business).
A.__________IS REQUIRED because the land is owned by someone other than myself or the
applicant business AND I HAVE NOTIFIED the landowner(s) by:
_______ actual notice for which I have a signed and dated receipt;
_______ service by sheriff or private process server for which I have an affidavit;
_______ service by certified mail restricted delivery for which I have a signed return
receipt; or
_______ legal publication, for which I have an affidavit of publication from the
newspaper, because the landowners could not be located through due diligence.
B.__________IS REQUIRED BUT INSTEAD of notice to the landowner(s), I notified the
lessor or administrator or executor of the land by the method checked above. (Briefly
explain here.)
IF THE APPLICANT DOES NOT OWN THE LAND, MY/ITS RIGHT TO USE THIS
LAND is by:
_____ lease.
_____ easement.
_____ (Other) ___________________________________________________.
_______________
Signature of Applicant or Applicant's Authorized RepresentativePosition
Name of Applicant (If Different from Signature Name)
_______________
Date Signed
APPLICATION INFORMATION
(Please circle one)
Type:
Air Quality Hazardous Waste Solid Waste UIC Water Quality Radiation
Name of Permit Requested:___________________________________________________
Application Tier: _____I
(if known)
_____II _____III
Permit No. ______________________
(if known, or previous number)
Name & Address of Facility:__________________________________________________
_____________________________________________________________
______________________________________________________________
*Complete and return to the DEQ program processing your permit.
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