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2. 
3. Dumpster Placement/Portable Storage Permit Application
5. Job Site Address:*
6. Applicant's Name: *
7. Is the applicant the owner or provider?*

   1. Owner
   2. Provider
9. PROPERTY OWNER
11. Name:*
12. Email Address:*
14. Address:*
16. City:*
17. State:*
18. Zip Code:*
20. Phone Number:*
21. Fax Number:
23. DUMPSTER OR PORTABLE STORAGE PROVIDER
25. Name:*
26. Email Address:*
28. Address:*
30. City:*
31. State:*
32. Zip Code:*
34. Phone Number:*
35. Fax Number:
37. Contact Person*
38. Contact Person Phone Number*
40. PLACEMENT LOCATION
42. Dumpster or Portable Storage Unit*
    -- Select One --DumpsterPortable Storage Unit
43. Placement Location:*
    -- Select One --StreetPrivate Property
44. Street Name & Address:*
45. Private Property*

    1. Driveway
    2. Yard
47. Dumpster or portable storage units placed on the street or public grounds must conform to the following:
    1) Unit must be placed at least 40 feet from any intersection. 2) Unit should have permit placard affixed to the dumpster. 3) Unit must be placed that they are visible at night from all angles of traffic flow. 4) Unit must be visible at night by means of reflecting tape, reflectors, cones, or other method as approved. 5) When required by the City Engineer, additional traffic control devices may be required to warn traffic of unit. 6) All required visibility devices and/or signage shall be provided by the applicant, owner, or person in charge.
49. DURATION OF PERMIT (Duration limits are determined by location.)
51. Private Property:
    Dumpster - 45 Days
52. Private Property:
    Portable Storage Units - 45 Days
53. Street or Public Grounds:
    Dumpster - 30 Days
54. Street or Public Grounds
    Portable Storage Unit - 14 Days
56. Date Dumpster/Portable Storage Will be Delivered:*
58. FEES
60. Private Property:
    NO CHARGE
61. Private Property Failure to Obtain Permit
    $50.00 (plus cost of permit)
62. Street or Public Grounds:
    $25.00
63. Street or Public Grounds Failure to Comply:
    $100.00 (plus costs)
65. EMERGENCY REMOVAL
    In the event of an emergency, any dumpsters or portable storage units in or upon any street or public grounds or upon private property may be removed by the Building Official or designated representative, and/or police, fire, or public utility personnel. The City shall not be liable for any loss or damage caused by such emergency removal.
67. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
69. Electronic Signature*
70. Date:*
    Date:
Leave This Blank:


72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit

* indicates a required field