Town of Greenwich Signature Required
Department of Public Works – Waste Disposal Division Fill-in Form, Print, and MAIL
Phone: (203) 618-3001
Holly Hill Residential Permit Form ’20 - ‘21
This permit application is for use by Greenwich households only. The Town of Greenwich will keep this as a record of your
application and your agreement to comply with facility regulations. Only one permit is necessary per household. Permits will be
issued on an annual basis; valid July 1
st
- June 30
th
.
Permit Fee: $25/annually
You must register with a valid Greenwich address. No PO Boxes. Permits will be mailed to the address listed below.
*Permits will no longer be issued/sold at Holly Hill*
Name
Last First
MI
Address
Street (Apt.# if applicable) City/Town State Zip Code
Telephone
No.
Email Address:
HOUSEHOLD VEHICLES:
Plate No. Make/Model/Year/Color
Plate No. Make/Model/Year/Color
Plate No. Make/Model/Year/Color
Plate No. Make/Model/Year/Color
By checking this box and signing below, I certify that the information I provided is correct and that I am a resident in the
Town
of
Greenwich; I will only use this permit to dispose of waste generated within my household. I will not share this
permit nor use it for other purposes; failure to adhere to the rules and policies of the Holly Hill Transfer Station may result
in revocation of your residential permit. I understand that the Town of Greenwich reserves the right to randomly stop and
verify the residency associated with the permit in use.
Signature/Date:
RETURN THIS COMPLETED APPLICATION BY MAIL WITH THE PERMIT FEE of $25.00 via check TO:
Town of Greenwich – DPW
Waste Disposal Division
101 Field Point Road
Greenwich, CT 06830
click to sign
signature
click to edit
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