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Application for Solid Waste Hauler Permit

  1. Application for Solid Waste Hauler Permit

    No permit will be issued until payment is received in full and processed by the staff of the City of Gardner Health Department

  2. In accordance with M.G.L c. 111, Section 31B, and Board of Health Regulations for "Removal, Transportation, and Disposal of Refuse in the City of Gardner," the undersigned makes application to the Board of Health for permission to remove and transport solid waste as set below:

  3. Please describe below the solid waste services you offer:

  4. Yours

  5. One Time Events

  6. Is recycling offered to your clients?

  7. Certification, Acknowledgement, and Electronic Signature

    I certify that the information I have provided is true and accurate. I recognize that it is a violation of this permit to dispose of solid waste anywhere other than the identified disposal locations or other approved by the Board in writing. I agree to comply with M.G.L. Chapter 111, Sections 31A, 31B, and any rules, regulations, or policy of the Gardner Board of Health.

  8. Under the Laws of the Commonwealth of Massachusetts, Chapter 233, Section 35, Acts of 1983, you are required to complete the following:

    Pursuant to M.G.L. Ch 62C, Sec 49A, I certify under the penalties of perjury, that I, to my best knowledge and belief, have filed all State tax returns and paid all State Taxes required by law.

  9. Required if applicable

  10. Payment:

    No permits will be issued until payment has been received in full and processed by the City of Gardner Health Department. All checks must be made out to "City of Gardner" and sent to Gardner Board of Health, Gardner City Hall Rm 29, 95 Pleasant St. Gardner, MA 01440. The fee for this permit is $150

  11. Leave This Blank:

  12. This field is not part of the form submission.