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2. Business Name *
3. Business Phone Number*
5. Contact Name*
6. Contact's Email Address*
8. Business Address*
   Street, City, State, Zip Code
10. Mailing Address, if different from above
    Street/PO Box, City, State, Zip Code
12. Property Owner*
14. Phone Number*
15. Email
17. Address where dumpster(s) will be located*
    Street Address Only
19. Hauler *
20. Phone Number*
22. 1st Dumpster - $100, Additional Dumpsters $50/each*

    1. One Dumpster - $100
    2. 2nd Dumpster - $50 (Total $150)
    3. 3rd Dumpster - $50 (Total $200)
    4. 4th Dumpster - $50 (Total $250)
    5. 5th Dumpster - $50 (Total $300)
24. Sketch Required:
    Before a permit will be issued, you must sketch an outline of property, showing the proposed location of the dumpster(s). Please indicate distance of each dumpster to property lines and other buildings, lot lines or boundaries. You may also submit a plot plan with the required information. This must be submitted to healthdept@winchester.us or mailed to Health Dept, 71 Mt. Vernon St, Winchester MA 01890.
26. Payment Options:
    Payment must be made before a permit will be issued. To pay online click below, or a check payable to "Town of Winchester" can be mailed to: Winchester Health Dept., 71 Mt. Vernon St, Winchester, MA 01890
28. Online Payment
    Fixed Commercial Dumpster Permit

    Once payment has been made, you need to return to this form and "submit."
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field