N.D. Admin. Code § 40-02-02-07
When the director has determined that grounds exist to revoke a permit, the procedures set forth in North Dakota Century Code section 28-32-05 must be followed.
History: Effective January 1, 1985. General Authority: NDCC 28-32-02 Law Implemented: NDCC 55-03-03
NORTH DAKOTA CENTURY CODE SECTIONS 55-03-01 OR 55-03-01.1
1. Applicant's Name: ____ Tel. #( ) __ Ext. Business Address: ____ State Zip____
2. The applicant is an (check one): ☐ individual/ ☐ organization/ ☐ institution/ ☐ company/ ☐ instrumentality of the state of North Dakota.
3. On a separate sheet of paper, or by attachment of a prospectus, describe the following as available to the applicant: a. Support facilities and personnel (include lab. as appropriate). b. Artifact storage facilities or storage agreements.
4. a. List the name(s) and area(s) of expertise of all individuals the applicant will utilize to perform supervisory or in-office evaluation work, or both, conducted under the permit applied for here (use continuation sheets as necessary): b. Attach a standard vita for each individual listed at 4a, above. c. List the name(s) of any individual(s) noted at 4a, above, for whom the applicant requests an exception to the minimum professional qualifications described at North Dakota Administrative Code (NDAC) section 40-02-02-05 (use continuation sheets as necessary): For each individual so listed, enclose documentation to justify the exception requested.
5. Type of permit applied for (check one): ☐ a. Annual permit required by North Dakota Century Code (NDCC) section 55-03-01 for activities related to satisfaction of state or federal review and compliance procedures. ☐ b. One-time permit required by NDCC section 55-03-01.1 for activities related to research to be conducted on land owned by an instrumentality of the state and not related to review and compliance procedures.
6. Enclose with this application one of the following as appropriate (check which enclosed): ☐ a. Annual permit fee ($50.00). ☐ b. One-time permit fee ($100.00). Also enclose a description of the legal location, the SITS number, and a copy of the research design for the activities proposed to be conducted under this permit. ☐ c. Documentation described at NDAC section 40-02-02-03. (For annual permit only.)
Permit fees must be made by check payable to: "State Historical Society of North Dakota." One-time permits granted will cover only those activities described in the research design submitted (6b, above).
7. Read and sign the following:
Application is herewith made for a permit related to NDCC section 55-03-01 or 55-03-01.1, which sections I have read and understand. The information provided above, and as attachments to this application, is correct and complete to the best of my knowledge.
(Signature of applicant or authorized representative)
STATE OF ) COUNTY OF ) ss.
On this _ day of _ in the year of _ before me personally appeared _ known to me to be the person who is described in and who executed the written instrument and acknowledged to me that the _______ executed the same.
(SEAL)
Notary Public My Commission Expires:
SHSND USE ONLY
Date received: _____
Reviewed by: _____
Date reviewed: _____
Action taken: _____
Date of action: _____