Solid Waste Haulers Application for Dumpster Placement Permit

Solid Waste Haulers’s Name:

Date Issued

Placement of Dumpster Address/:

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Reason for Dumpster Placement:

Requested Length of Time for Dumpster Placement:

Start

Finish

NOTE: THIS PERMIT IS VALID ONLY FOR THE TIMEFRAME SPECIFIED ON THIS PERMIT. ANY EXTENSTION MUST BE APPROVED BY THE BOROUGH MANAGER.

Approved By:

Date:

Permit Expiration Date: