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Worksite Location
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In order to expedite the review of your Dumpster Permit application, fill out the application in its entirety, including a map of proposed placement in space provided, and email address to which we can send your permit upon approval.

Selected Address
Block
Lot
City, State, Zip
Applicant Information
Name
Address
City, State, Zip
Email
Phone #
(Email Address to which Permit will be sent upon approval.)
Dumpster Company Information
Name
Phone #
Address
City
State
ZIP
Contact Name
Contact Email
Dumpster Location
Corner Lot?
Location Type
Start Date
End Date
  1. Dumpsters Placed in the street MUST get clearance from the Clark Police Department and are limited to 7 days.
  2. Dumpsters placed in the driveway are limited to 14 days.
Please indicate the proposed location on the map.
Fee
  • Dumpster permit is valid for 30 days from Approval Date.
Certification
All on-street dumpsters require pre-approval before unit is delivered. All dumpsters must be removed on or before end date stated on this application. Dumpsters still in place after the stated and approved end date will be considered to be in violation, and may result in the issuance of penalties.

I certify that the information provided is correct and true to the best of my knowledge.
Applicant Signature:
Type Full Name :