2. 
4. Application for a Temporary Dumpster Permit
6. Applicant's Name*
8. Applicant's Address*
10. Applicant's Phone #*
12. Dumpster Provider*
14. Reason for Dumpster*
16. Location of Dumpster*
18. Exact date it will be place*
    Exact date it will be place
19. Date it will be removed*
    Date it will be removed
21. Special Conditions (if any)
23. Click below to open/print Dumpster Placement Form.
    Open Form
24. Attach completed dumpster placement form
26. I have read the Temporary Dumpster Requirements and agree to adhere to those requirements and the requirements as outlined in the Code of the Borough of Ephrata, Chapter 277, Article IV, Temporary Dumpsters on Street, at all times.
28. Name*
    By entering your name and date above, you are signing this form and agreeing to all terms and conditions of this application.
29. Date*
    Date
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field