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2. APPLICATION FOR SHORT TERM DUMPSTER PERMIT
4. (Permit must be posted conspicuously on same location as dumpster)
   FEE: $40 per dumpster
6. I hereby make application to the Board of Health to have a dumpster stored on the premises from which the contents are to be removed or transported or disposed of by a contractor engaged in transporting for compensation in accordance with Chapter 111, Section 5, of the Massachusetts General Laws, as amended and subject to the rules and regulations of the Board of Health. Shortterm dumpsters are not to exceed 12 months.
8. Applicant Information
10. Name
12. Business/Property Owner/Manager
13. Telephone
15. Address of Dumpster
16. Amount Enclosed
18. Disposal Company Name
20. Note: Section 20.50 states the Contractor supplying the removal, transport or disposal of waste, debris, etc. must also obtain a permit for such disposal from the Board of Health.
22. Applicant Signature
23. Date
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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