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Site Owner and Site Operator Disclosure (LPC-PA24A)

Site Owner and Site Operator Disclosure (LPC-PA24A) 2025

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The document is a form titled 'Site Owner and Site Operator Disclosure (LPC-PA24A)' required for interim authorization applications related to clean construction or demolition debris operations in Illinois. It mandates detailed disclosure of ownership information for site owners and operators that are not sole proprietorships or government entities, including direct ownership, intermediary entities, and ultimate ownership structures. The form also specifies requirements for publicly traded entities regarding the identification of significant shareholders.

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Click ‘Get Form’ to open the Site Owner and Site Operator Disclosure (LPC-PA24A) in the editor.
Begin with Section I, 'Site Identification.' Fill in the facility name, office phone number, physical site location, state (IL), city, county, zip code, and township. Ensure all information is typed or printed legibly.
Move to Section II for 'Site Owner/Site Operator Information.' Provide detailed ownership information for each individual or business entity that has an ownership interest in the property or operation. Include names, addresses, phone numbers, and ownership interests.
For direct ownership details, list each owner’s information as specified. If applicable, include details for trusts holding ownership interests.
If there are intermediary entities involved in ownership, outline them hierarchically along with their owners. Ensure ultimate ownership is traced back to individuals with direct or indirect interests.
For publicly traded entities, provide names and percentage ownership of individuals or entities owning more than five percent of voting shares as required.

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