CITY OF READING

BUILDING/TRADES DIVISION

APPLICATION FOR DUMPSTER/CART PERMIT

PERMIT NUMBER:__________________DATE PERMIT ISSUED:______/______/______

TO BE COMPLETED BY APPLICANT

LICENSED HAULERS NAME: ____________________________________________________
LICENSED HAULERS ADDRESS: _________________________________________________
CITY/STATE/ZIP CODE: ________________ PHONE: #( )__________________________
ADDRESS OF CONTAINER LOCATION: ____________________________________________
SIZE OF CONTAINER: __________ PURPOSE OF CONTAINER: _______________________
TEMPORARY DUMPSTER ____ PERMANENT DUMPSTER _____ PERMANENT CART _____
START DATE: _________________________ END DATE: __________________________
CONTAINER WILL BE LOCATED:
1. STREET ___ SIDEWALK ___ ALLEY ___
2. FRONT OF PROPERTY ___ REAR OF PROPERTY ___ SIDE OF PROPERTY ___
MEETS CONDITIONS OF ORDINANCE 17-99: ___
PROPERTY OWNER NAME: _____________________________________________________
PROPERTY OWNER MAILING ADDRESS: __________________________________________
___________________________________ (____) ____ - _________ ___/___/___
SIGNATURE OF APPLICANT PHONE NUMBERDATE

TO BE COMPLETED BY DEPARTMENT OF PUBLIC WORKS

DATE RECEIVED BY PUBLIC WORKS: ____________________
INSPECTION DATE: ___/___/___    INSPECTOR ASSIGNED: ____________________
MEETS CONDITIONS OF ORDINANCE 17-99 __
APPROVED BY: ___________________  ___/___/___  __________________________  ___/___/___
(INSPECTOR) (DATE) (SERVICES MANAGER) DATE)
AMOUNT DUE $ ______________ AMOUNT PAID $ ______________ DATE PAID ___/___/___
DATED COVERED BY PERMIT ___/___/___ TO ___/___/___

HOLD HARMLESS AND INDEMNIFICATION AGREEMENT

KNOW ALL MEN BY THESE PRESENT THAT:

                                                                            of                                                                  
(Name)                                                                   (Address)

in consideration of the City of Reading issuing a permit permitting the placing or erecting

a dumpster on property located at                                                                 , Reading, PA

or on the sidewalk or street abutting the property, hereby agrees to hold the City of Reading, its officers, agents, servants, employees, and their successors, harmless from any claims by persons or entities arising out of the location, condition or use of said dumpster; and further agrees to indemnify the City of Reading , its officers, agents, servants, employees, and their successors, against any loss as a result of claims of persons or entities arising from location, condition or use of said dumpster.

IN WITNESS WHEREOF, the above named, intending to be legally bound, has executed this Hold Harmless and Indemnification Agreement this                                                        day of

                                           , 20         .

Signature

(if Corporation identify by name and include title of officer signing agreement)

ATTEST: