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Special Assistance Request for Back Door Sanitation Pickup

  1. Contact Details
  2. Address Where This Service is Requested
  3. Within 90 days of requesting back door sanitation service, applicants must provide proof of need by providing a letter from their doctor or a photo of their handicap hang tag. Either item may be uploaded here or a copy may be brought to the front desk at City Hall.

  4. Please confirm

    I, the undersigned claimant, do solemnly swear that I am a full-time resident at the above address; I am disabled to the extent that I am incapable of moving my garbage container to the curb; and no able-bodied individual resides at the address above.

  5. I confirm the above is true and correct.*
  6. Leave This Blank:

  7. This field is not part of the form submission.