CITY OF
*Check appropriate permit:
_____ WASTE HAULERS PERMIT: Issued for the collection
and transportation of garbage, offal or other offensive substances collected
WITHIN the City of
_____ SEPTAGE HAULERS PERMIT: Issued to those who pump or transport the contents of any part of an individual sewage disposal system.
_____ CERT. OF REGISTRATION: Issued for the transportation
of garbage, offal, or other roughly offensive substances collected OUTSIDE the City of
APPLICANT: _____________________________________________________________
HOME ADDRESS: __________________________________________________________
NAME OF BUSINESS: ______________________________________________________
BUS. ADDRESS: __________________________________________________________
DISPOSAL DESTINATION OF THE SUBSTANCES TRANSPORTED OR COLLECTED:
__________________________________________________________________________
LICENSE PLATE NUMBERS OF ALL VEHICLES TO BE USED:
___________________________________________________________________________ ___________________________________________________________________________
PERMITS ARE NOT TRANSFERABLE WITHOUT THE BOARD'S APPROVAL FEE: $100.00 PER VEHICLE
The Board of Health, City of