Fillable City of Coppell Environmental Health Department WASTE HAULERS (City of Coppell)

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City of Coppell Environmental Health Department WASTE HAULERS (City of Coppell)

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City of Coppell
Environmental Health Department
WASTE HAULERS PERMIT APPLICATION
________________________________________________________________________________
P.O. Box 9478, Coppell, Texas 75019-4409 972-462-5177
Business Name___________________________________________________ Phone #__________________________
Business Street Address ____________________________________________________________________________
City _______________________ State______ Zip Code ___________ email _________________________________
Primary Contact ___________________________________ Title ____________________ Phone _________________
Alternate Contact __________________________________ Title ____________________ Phone _________________
Vehicle Type Vin # License # Capacity/Gallons
Waste Removed From: _____Trap (Grease, Oil, Sand) (Check all that apply)
_____Septic Tank _____Waste Storage Tank _____Chemical/Portable Toilet
Name, Address, & Phone # of Dumping Sites:
1.________________________________________________________________________________________
2.________________________________________________________________________________________
3.________________________________________________________________________________________
I attest that the information provided above is true and accurate. I agree to comply with the City of Coppell rules and
regulations and understand that failure to do so may result in revocation or suspension of the permit.
The permit is effective for one year from the date of issuance unless sooner revoked for a cause.
The permit is not transferable and the permit fees are non-refundable.
Enclose a check or money order in the amount of $100.00 payable to the City of Coppell. Additional vehicles are
$10.00 per vehicle.
____________________________________________ _______________________________
Signature of Applicant Date
Submit application and fee to City of Coppell, Environmental Health, P.O. Box 9478, Coppell, Texas 75019
OFFICE USE ONLY
Approved By_______________________________________________ Date of Approval__________________
Receipt No. ________ Check # ________ Amount $ ________ Received By ________ Date _____________
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City of Coppell Environmental Health Department WASTE HAULERS (City of Coppell)

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Completed 2 August 2020

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