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Request Off Street Garbage Collection Assistance
Full Name
First Name
*
Last Name
*
Email
*
Phone Number
*
Service Address
Address or Location
Utility Number
*
Please describe the physical disability that prevents you from placing garbage containers next to the roadway.
*
Is there any other person, including household or domestic help, that could assist you in placing your garbage container next to the roadway?
Yes
No
Do you agree to notify the sanitation division when the conditions for this service are no longer applicable?
Yes
No
Are you employed?
Yes
No
Please provide information below for two contacts we can call in case of emergency:
Emergency Contact 1
First Name
*
Last Name
*
Emergency Contact 1 Phone Number
*
Emergency Contact 2
First Name
*
Last Name
*
Emergency Contact 2 Phone Number
*
Acknowledgements
Please check this box to acknowledge that medical verification of your disability may be necessary.
Acknowledgement
Check the box to acknowledge that special garbage collection assistance is available to you only while you are physically unable to place your garbage by the road and that you have no other way (or individual to help) to place the container by the roadway?
Acknowledgement
By checking the box, you acknowledge your understanding that all garbage collected by the Huntsville sanitation division must be bagged and each bag cannot weigh more than 50 pounds.
Acknowledgement
By checking this box, you acknowledge your understanding that each collection is limited to the garbage contained within the automated garbage cart and does not include overflow.
Acknowledgement
By checking the box, I hereby grant the City of Huntsville permission to use said private property and agree not to hold the City of Huntsville liable for any damages resulting from the collection service, providing that this request is approved and your driveway or private property has to be used to access.
Acknowledgement
By checking the box, you acknowledge this request is for garbage collection only. Any yard waste or trash items outside of a container must be placed at the curb.
Acknowledgement
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Last Name
Email
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