Skip to Main Content
Government
Business
Residents
Play
A to Z
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
Ask a Question
Budget
Cemeteries
City Assessor
City Manager - Office of Resilience
Commissioner of the Revenue
Commissioner of the Revenue - Vehicle Form
Communications
Community
Community Services Board
ComTech
Economic Development
EERC
Emergency
Family & Human Services
Fire-Rescue
General Services
Geographic Information Systems
Housing Solutions
Human Resources
Information Technology
Keep Norfolk Beautiful
Neighborhoods
NorfolkWorks
Parking
Planning
Police
Public Health
Public Works
Purchasing
Utilities
Volunteer form
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
Bulk Refuse Container Application/Permit
This form has been modified since it was saved. Please review all fields before submitting.
Contact Information
Application Status
New
Renewal
Temporary
Refuse Container Application/Permit
Company Name
Billing Name
Address
City
State
Zip Code
Telephone Number
*
Fax Number
Email Address
*
Container Address
Address
City
State
Zip
Type of Service
*
Temporary
Annual
Type Establishment
Food Related
Residential
Number of Units Served
Industrial
Construction Site
Commercial
Other
Number of Units
-- Select One --
1
2
3
4
5
More than 5
More than 10
More than 100
If Other
Agreement
<ul> <li>I agree to conform to the ordinances governing the use of bulk containers and will permit such inspections and examinations as may be deemed necessary by the Director of Public Health. </li> Copies of codes are available upon request. <li>I agree to notify the Bureau of Environmental Health Services immediately of any changes in management, services or when the applicant ceases to be responsible for the bulk container. </li> <li>I understand that this permit is valid only for the location for which it was issued and is not transferrable from one location to another; nor from one owner to another. </li> </ul>
I agree to conform to the ordinances governing the use of bulk containers and will permit such inspections and examinations as may be deemed necessary by the Director of Public Health.
Copies of codes are available upon request.
I agree to notify the Bureau of Environmental Health Services immediately of any changes in management, services or when the applicant ceases to be responsible for the bulk container.
I understand that this permit is valid only for the location for which it was issued and is not transferrable from one location to another; nor from one owner to another.
Note: It is recommended that the bulk container site plans to be reviewed prior to construction.
Applicant's Signature
Date
Date
Print Name
Title
Payment Type
-- Select One --
Check
Mastercard
Visa
Credit Card Number
CCV
Expiration Date
Expiration Date
Cardholder's Name
Signature
Please make checks payable to:
Norfolk Department of Public Health
830 Southampton Ave
Norfolk, VA 23510
Permit Number:
Issue Date:
Issue Date:
Expiration Date:
Expiration Date:
PD:
Rect Date
Rect Date
Invoice Number
Check Number
Received By:
Ecode:
Site Inspection by:
Date:
Date:
Exempt:
-- Select One --
Yes
No
Approved By:
Date:
Date:
CashBook Date:
CashBook Date:
By:
Posted Date:
Posted Date:
By:
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
Submit and Print
* indicates a required field
Sign Up for City Updates
MyNorfolk
Permits
Pets
Parking
Public Safety
Vehicle Auction
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow