Household Waste Permit Application

2. Wicomico County Resident Household Waste Permit Application
6. General Rules for Household Refuse Permits
8. Please Read the General Rules for Household Refuse Permits
   General Rules For Household Refuse Permits
9. By checking this box you confirm that you have read and agree to the General Rules for Household Refuse Permits*

   1. I have Read and Agree *

   *Required for issuance of Permit

13. Resident Information
15. Last name*
16. First Name*
17. Middle Initial*
19. Street Address*
20. City/Town*
21. Zip Code*
23. Mailing Address (If Different)
24. Mailing City/Town
25. Mailing Zip Code
27. E-MAIL Address
    Enter an E-mail Address if you wish to recieve information about this application by E-Mail
28. Telephone Number
32. Vehicle Information
34. Number of Vehicle Stickers Needed*

    1. One (1) - Annual Cost - $60
    2. Two (2) - Annual Cost - $90
    3. Three (3) - Annual Cost - $150
    4. Four (4) - Annual Cost - $180
35. Provide Vehicle information, below, only for those vehicles which will receive a Permit Sticker
37. Registration Documention Requirement for Each New Vehicle Permits
    A valid registration, showing a Wicomico County address, is required for any new permits but are not required for a renewal. If you do not have a way to upload the registration, please mail the application with the registration copy to the Solid Waste Office with a check payment or bring the registration to the office. Cash, checks and credit cards are accepted at the office.
39. Once your application is verified, the Solid Waste staff will contact you by email with payment options. ------- If you did not provide an email address, please mail a check payment to 6948 Brick Kiln Road Salisbury, MD 21801.
43. Vehicle #1
44. Make*
45. Model*
46. Color*
48. Vehicle Year*
49. Vehicle Tag #*
    Vehicle License Plate #
50. Tag State *
51. Vehicle Type*

    1. Automobile
    2. Pickup Truck
    3. Van
    4. SUV
    5. Other
53. Attach Image of Vehicle 1 Registration
57. Vehicle #2
58. Make (#2)
59. Model (#2)
60. Color (#2)
62. Vehicle #2 Year
63. Vehicle 2 Tag #
    Vehicle 2 License Plate #
64. Tag State (#2)
65. Vehicle #2 Type

    1. Automobile
    2. Pickup Truck
    3. Van
    4. SUV
    5. Other
67. Attach Image of Vehicle 2 Registration
71. Vehicle #3
72. Make (#3)
73. Model (#3)
74. Color (#3)
76. Vehicle #3 Year
77. Vehicle 3 Tag #
    Vehicle 3 License Plate #
78. Tag State (#3)
79. Vehicle #3 Type

    1. Automobile
    2. Pickup Truck
    3. Van
    4. SUV
    5. Other
81. Attach Image of Vehicle 3 Registration
85. Vehicle #4
86. Make (#4)
87. Model (#4)
88. Color (#4)
90. Vehicle #4 Year
91. Vehicle 4 Tag #
    Vehicle 4 License Plate #
92. Tag State (#4)
93. Vehicle #4 Type

    1. Automobile
    2. Pickup Truck
    3. Van
    4. SUV
    5. Other
95. Attach Image of Vehicle 4 Registration
Leave This Blank:


97. 1. Receive an email copy of this form.
98. Email address

    This field is not part of the form submission.

99. Submit

* indicates a required field