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2. Permit must be renewed yearly.
4. First & Last Name*
6. Property Address*
8. Phone Number*
9. Email Address*
11. Number of Loads Requested*
13. I hereby authorize the City of Gardner to dump fill on my property at no obligation to the City. At no time will the City be responsible for removal of this fill. I understand the material may not be clean and have debris contained within each load.*

    1. I agree
15. I will check with Conservation Commission and obtain any permits concerning wetlands and present them to the Department of Public Works prior to any loads being delivered.*

    1. I agree
17. I hereby accept all responsibility for this fill.*

    1. I agree
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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

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