Date: ______________________
Approved by: ________________
Title: _______________________
ROW Permit #: ______________
Z:\Forms\temp\Dumpster Permit.doc Page 1 of 1 Last updated on June 18, 2013
ROW Dumpster Permit
1. Applicant Information
Name: __________________________________________________________________
Address: ________________________________________________________________
City, State, Zip: __________________________________________________________
Phone Number: __________________________________________________________
This document allows ___________________ to place a dumpster in front of
_____________________________. The dumpster is required to have proper
protection so it remains safely on the project site.
The fee for work within right-of-way is authorized by Municipal ordinances.
A work within right-of-way fee (Ord. 515.030) = $10.00
Protective Measures (Ord. 515.070) Warning and Safety Devices
**Permit valid 15 days from approval date.
Conditions:______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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