Bulk Waste Container Permit Application Form
City Amenity & Compliance
1. Applicant DetailsName
Business Name (if applicable) / ABN (if applicable)
Street address
Postcode
Mailing address
Postcode
Phone number / Mobile number
Email address
2. Application
Tick the relevant application type below
FEE / CODE
One Bulk Waste Container
On Nature Strip (6 months max.) On Road (3 day permit) Other:______/ $80 / 517
Placement Location
Address: ______Postcode: ______
Placement Date:____/____/____ Collection Date:____/____/____
Dimensions of Bulk Waste Container
Height: m Width: m Length: m Cubic volume: m²
3. Public liability insurance requirements
Each application must have a Public Liability Insurance Policy that has a Principles Indemnity Clause. You must provide a copy of your Certificate of Currency containing the following information, as a minimum (a Certificate of Currency can be obtained from your insurer/insurance agent):
· The name of the Insurance Company
· The name of the business
· The name of the insured
· A business description
· Type of Insurance
· Period of Insurance Cover
· Sum insured for minimum value of $10 million
· Policy cover for Principles Indemnity
· City of Melton must be listed as an interested party
NOTE
Please ensure the Bulk Waste Container permit conditions are adhered to for duration of the permit.
No asbestos waste is permitted.
Bulk Waste Container placement must comply with VicRoads Code of Practice for Placement of Waste Bins on roadsides.
Please attach a valid certificate of currency from the supplier.
Incomplete applications will be returned to the applicant.
Please complete this form together with payment at least 2 weeks prior to the placement date.
PAYMENT PROCESS: VISA / MASTERCARD #
Bulk waste container fee $80 (Code 517). This application fee is non-refundable if the permit is rejected.
Applications will not be processed until payment of the application fee is received by Council. Incomplete applications will not be accepted. This fee is non-refundable if the permit is rejected.
Your signature below is an authority for Council to issue a sales voucher for the amount shown below as your payment for the Bulk Waste Container Application Fee.
Credit Card Number:
Card Holders Name: / Expiry Date: / /
Card Holders Signature: / Amount Payable:
· Please return completed forms to:
Mail: Melton City Council, PO BOX 21, Melton VIC 3337
Email: (max. file size: 10MB)
· Alternative payment options can be made at any Council office or library location, or via Cheque or Money Order.
· Cheques & Money Orders should be accompanied with this application form and made payable to the Melton City Council, PO BOX 21, Melton VIC 3337. Cheques should be marked Not Negotiable.
Privacy Statement: The personal information requested on this form is being collected by Council for the purpose of meeting its legal obligations under the Road Safety Act1986, Environment Protection Act 1970, Summary Offences Act 1966, Local Government Act 1989, Impounding of Livestock Act 1994, Domestic Animals Act 1994, Infringements Act 2006 and associated or related legislation. The information will be kept confidential and identifying information will not be disclosed to any person for any other purpose. You may access your own information by contacting Council's City Amenity and Compliance team on 9747 7200.
OFFICE USE ONLY (CSU)
Picked Up On: / / Time...... Initials:......
Certification Fees (Receipt Type 517) Ledger No: 02440.0820.0824...... (No GST Payable) / Amount: