neighborhood clean-up application

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Neighborhood Cleanup Application DUE THREE WEEKS PRIOR TO SCHEDULED CLEANUP DATE City of Dayton, Ohio Dept. of Public Works Cleanup Location (eg. neighborhood) Cleanup Date: Cleanup Time: Applicant Information Applicant Name: Organization: Applicant Address: City: State: ZIP: Applicant Phone: Applicant Email: Cleanup Information Number of Volunteers: Service Locations (see next page for additional space) Applicant Signature Date Office Use: Date Received: Date Approved/ Denied: Approved Denied Scheduled Pickup Date: Items to be Picked Up - Check All That Apply Location (Address or Intersection) Bulk Waste - Furniture Bulk Waste - Metal/Appliances Yard Waste Tires Submit application via mail, fax, or email to Verletta Jackson Department of Planning and Community Development, City of Dayton 101 W Third Street, 6th Floor, Dayton, OH 45402 [email protected] Fax: 937-333-4281 Definitions: Bulk Waste - appliances, furniture, mattresses, box springs, toys, carpet, and draperies and like materials normally found in a residential unit. Bulk Waste does not include demolition matter, infectious waste or hazardous waste. Yard Waste - trimmings from bushes, shrubs, and trees not exceeding two (2) inches in diameter or four (4) feet in length, and which are securely packaged or bundled together, including vegetative matter. Demolition Matter - those items removed from a structure under construction, repair or demolition, such as brick, concrete, stone, glass, wallboard, framing and finishing lumber, roofing materials, plumbing, plumbing fixtures, wiring and insulation material. DEMOLITION MATTER IS NOT ELIGIBLE FOR PICKUP. Instructions: 1. Complete application and submit three weeks prior to event. 2. Wait for notification of approval of event. 3. Contact Montgomery County Solid Waste for supplies and dumpsters. 4. On the day of event, ensure that there is proper clearance away from parked cars, garages, over hanging tree limbs and wires. Bed bug items should be completely wrapped and sealed before setting out for pick up. 5. Separate items into each specific category. Household hazardous waste is accepted at Montgomery County Transfer Stations. Visit mcohio.org or call 937-225-4999 for more information. Notes:

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Download this form to coordinate a clean-up in your Dayton neighborhood! Applications are due 3 weeks prior to scheduled event. Submit application via mail, fax, or email to Verletta Jackson Department of Planning and Community Development, City of Dayton 101 W Third Street, 6th Floor Dayton, OH 45402 [email protected] Fax: 937-333-4281

TRANSCRIPT

Page 1: Neighborhood Clean-Up Application

Neighborhood Cleanup ApplicationDUE THREE WEEKS PRIOR TO SCHEDULED CLEANUP DATE

City of Dayton, Ohio Dept. of Public Works

Cleanup Location (eg. neighborhood)

Cleanup Date: Cleanup Time:

Applicant Information

Applicant Name: Organization:

Applicant Address: City: State: ZIP:

Applicant Phone: Applicant Email:

Cleanup Information

Number of Volunteers:

Service Locations (see next page for additional space)

Applicant Signature Date

Office Use:Date Received:

Date Approved/Denied:

Approved

DeniedScheduled Pickup Date:

Items to be Picked Up - Check All That Apply

Location (Address or Intersection) Bulk Waste - Furniture

Bulk Waste - Metal/Appliances Yard Waste Tires

Submit application via mail, fax, or email to Verletta Jackson

Department of Planning and Community Development, City of Dayton 101 W Third Street, 6th Floor, Dayton, OH 45402

[email protected] Fax: 937-333-4281

Definitions: Bulk Waste - appliances, furniture, mattresses, box springs, toys, carpet, and draperies and like materials normally found in a residential unit. Bulk Waste does not include demolition matter, infectious waste or hazardous waste. Yard Waste - trimmings from bushes, shrubs, and trees not exceeding two (2) inches in diameter or four (4) feet in length, and which are securely packaged or bundled together, including vegetative matter. Demolition Matter - those items removed from a structure under construction, repair or demolition, such as brick, concrete, stone, glass, wallboard, framing and finishing lumber, roofing materials, plumbing, plumbing fixtures, wiring and insulation material. DEMOLITION MATTER IS NOT ELIGIBLE FOR PICKUP.

Instructions: 1. Complete application and submit three weeks prior to event. 2. Wait for notification of approval of event. 3. Contact Montgomery County Solid Waste for supplies and dumpsters. 4. On the day of event, ensure that there is proper clearance away from parked cars, garages, over hanging tree limbs and wires. Bed bug items should be completely wrapped and sealed before setting out for pick up. 5. Separate items into each specific category.

Household hazardous waste is accepted at Montgomery County Transfer Stations. Visit mcohio.org or call 937-225-4999 for more information.

Notes:

Page 2: Neighborhood Clean-Up Application

Items to be Picked Up - Check All That Apply

Location (Address or Intersection) Bulk Waste - Furniture

Bulk Waste - Metal/Appliances Yard Waste Tires