Household Waste Permit Application

2. Wicomico County Resident Household Waste Permit Application

6. Rules and Regulations For Household Refuse Permits

8. Please Read the Rules And Regulations For Household Refuse Permits
   Rules And Regulations For Household Refuse Permits

9. By checking this box you confirm that you have read and agree to the Rules and Regulations 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 - $60
    3. Three (3) - Annual Cost - $120
    4. Four (4) - Annual Cost - $120
35. Provide Vehicle information, below, only for those vehicles which will receive a Permit Sticker

    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.

    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.

    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