Forms Module

2. Use this form to request an exemption from Chapter 14, Article V: Environmentally Acceptable Packaging and Products.
4. ESTABLISHMENT INFORMATION
6. Name of Business or Organization: *
7. Address
9. City*
10. State*
11. Zip
15. PRIMARY POINT OF CONTACT
17. Name:*
18. Email address:*
19. Phone number:*
23. Exemption requested:*

    Please choose one.
    -

    1. Undue Hardship or Practical Difficulty (includes excess inventory) not generally applicable to other persons in similar circumstances (up to one year, applies to entire Article V)

    1. Public Health and Safety Requirement or Medical Necessity to use the product (up to one year, applies to foam products only)
25. Which regulations does this application for an Undue Hardship or Practical Difficulty apply to?*

    Please choose all that apply (and that you have facts to support)
    -

    1. Providing single-use plastic carryout bags
    2. Providing disposable food service ware made of polystyrene/foam
    3. Providing disposable food service ware that is non-recyclable or non-compostable
    4. Selling or renting polystyrene foam products
29. Please describe in detail the basis of your request, include and explain factual support for the claimed exemption.
    Requests without facts and/or that show lack of effort WILL NOT be approved.*
    Please attach files that show factual documentation to support your request.
31. File attachment #1
32. File attachment #2
33. File attachment #3
35. How long are you requesting this exemption for?*
    Exemptions are limited to one year or less.
39. Applicant acknowledgement*

    1. I agree with the below statement

    I hereby acknowledge by my agreement above that this application is accurate and confirms that I represent all legal owner(s) of the subject establishment. I understand that additional information or clarification may be requested during the review process prior to approval, and will submit appropriate documentation and allow inspections as requested by City staff. I understand this request needs to be verified by City staff prior to receiving approval of this application (in whole or in part, with or without conditions), and until an approval is received I will continue to abide by the City of Charleston Code Chapter 14, Article V: Environmentally Acceptable Packaging and Products.
41. Link
    View ordinance and associated resources
43. More information
    Staff will aim to review complete requests as soon as possible and within a two week period.
    Please note, approved requests may be posted publicly on the City's webpage.
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field