Fillable Dumpster Permit Application (City of Salina)

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Dumpster Permit Application (City of Salina)

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12/18/15
Dumpster Permit Application
Department of Public Works / Engineering
FOR OFFICE USE ONLY
Permit No.: ___________________ Permit Issued: ____________
Expiration Date: ____________
Property Address: ___________________ Permit Fee: ____________
Special Conditions: __________________________________________________________________
Action: Approval Denial
_______________________________________ _________________________ ____________
Signature of Reviewer Title Date
Permit Information
(Please Print)
Written plan of action from applicant shall include the following:
Barricades, Lights, Cones, Tape (safety of pedestrians and vehicle traffic)
Daily cleaning of area
Containment of debris in dumpster area
Defined pick-up and removal schedule
Site Plan
Compliance with appropriate municipal code requirements
Type of Building Commercial / Industrial Residential
Dumpster Location On Property On Street
(No dumpsters shall be placed upon a sidewalk)
Time Period for Dumpster Placement: Start Date: _______________________
Finish Date: _______________________
Container Vendor: ______________________________________________________
Property Owner: ______________________________________________________
Property Owner Address: ______________________________________________________
Contractor / Applicant: ______________________________________________________
Contractor / Applicant Address: ______________________________________________________
Contractor / Applicant Phone No. _______________________Fax No.________________________
Contractor / Applicant E-mail__________________________________________________________
I hereby certify that this permit is pursuant to work authorized by the owner of record and I am authorized to make this application as the authorized agent and
we agree to conform to all applicable laws of jurisdiction. Failure to comply with the provision set forth in the municipal code requirements regarding the
placement and care of dumpsters will cause this permit to be revoked and/or the filing of criminal charges necessary to provide compliance.
Signature of Applicant: ___________________________________________ Date: _____________
Cc: Public Works / Streets; Salina Fire Department; Salina Police Department; Salina Downtown; File
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Dumpster Permit Application (City of Salina)

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Completed 16 July 2020

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