Type Full Name :

Sign With Hand

I acknowledge that all the statements made herein and accurate and this application will not be accepted as submitted until all the required documents are remitted and all the applicable fees are paid.

Company Name

Trade Name *

According to ordinance #2-2013 the fee is $100 per vehicle.

Describe in detail the character and type of substance dumping.

Please list all the vehicles being used for landscaping operations and/or attach related documents to the attachments section below.

Attachment

State the location where the debris is to be taken.

Insurance Company

ZIP *

Address *

Company Phone #

Insurance Company

Fee

IMPORTANT: Please note that the landscapers are no longer allowed to register more than 5 vehicles.

If "Yes", provide State License #

State *

City, State, ZIP

If you intend to dump vegetative waste, you must enter the number of dumps below:

City *

You must provide proof of general liability insurance, you may also attach client details & vehicle details to this section or you may bring them in person to the office.

Certification

The name and telephone number of the company/organization to receive said debris

Fee Vehicle

Receiving Company

Client Information

Applicant Information

Vehicle Information

Business Information

Please list the names and addresses of all clients serviced in North Haledon and/or attach Client list to the attachments section below.

Phone # *

Provider Full Address

Please note: There is now a dumping fee of $25.00 per dump and vouchers can be purchased in the Municipal Clerk’s office.

Last Name *

Are you a registered contractor with the State of NJ, Dept of Consumer Affairs? *

Fee Dump

The name and address of the provider of General Liability Insurance

Commercial Landscaper Permit

103 Overlook Ave
North Haledon, NJ 07508
(973) 427-7793
www.northhaledon.com

Amount Due

Number of Vehicles

Applicant Signature *

First Name *

Borough of
North Haledon

Email *