CITY OF HAVERHILL

APPLICATION FOR DUMPSTER PERMIT

COMPANY:

COMPANY NAME (PROVIDING DUMPSTER)__________________________________

COMPANY ADDRESS____________________________________________________

COMPANY TELEPHONE NUMBER___________________________________________

CONTACT PERSON'S NAME______________________________________________

*LOCATION:

PROPOSED ADDRESS OF DUMPSTER_______________________________________

COMMERCIAL PROPERTY?:_____________ HOW MANY UNITS?_________________

RESIDENTIAL PROPERTY?:____________ HOW MANY UNITS?_________________

BUSINESS/RESIDENT'S NAME___________________________________________

CUBIC YARDS OF DUMPSTER_______________ (EACH DUMPSTER MUST BE OF

SUFFICIENT SIZE AND CAPACITY TO ELIMINATE OVERFLOWING.)

DISTANCE OF PROPOSED DUMPSTER FROM LOT LINES?______________________

___________________________________________________________________

PLEASE MAIL OR DELIVER APPLICATION(S) WITH APPROPRIATE FEE (S) TO:

INSPECTIONAL SERVICES ROOM 210 - 4 SUMMER ST., HAVERHILL, MA 01830.

ONCE YOUR APPLICATION HAS BEEN PROCESSED YOU WILL BE MAILED A PERMIT THAT MUST BE AFFIXED TO THE FRONT OF EACH DUMPSTER.

NO ADDITIONAL DUMPSTERS MAY BE ADDED DURING THE CALENDAR YEAR WITHOUT FIRST OBTAINING A PERMIT FROM THIS DEPARTMENT. FAILURE TO COMPLY WILL RESULT IN A $75.00 FINE FOR EACH OFFENSE OF THE DUMPSTER REGULATIONS. (SEE ENCLOSED REGULATIONS)

PERMIT #_________                   EXPIRATION DATE_______________

*IF YOU HAVE MULTIPLE LOCATIONS, AN APPLICATION NEED NOT BE FILLED OUT FOR EACH OF THEM. AFFIX YOUR CUSTOMER LIST WHICH INCLUDES ADDRESSES AND YOUR APPLICATION WILL BE PROCESSED.

RENEWAL FEE IS EACH LOCATION $10.00 PER DUMPSTER ; FEE FOR NEW LOCATION IS $25.00 PER DUMPSTER.