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Household Waste Recycling Centre Permit Application

Note: For this form to be processed details highlighted with a * must be completed

Section 1. Contact Details

*	Title
*	First Name
*	Surname
*	Address
*	Postcode
*	Email
*	Contact Daytime Telephone Number/s
	Home
	Mobile

Section 2. Permit Details

* In this application are you disposing of mixed waste or garden waste only?
Mixed Wastes Garden Waste

If choosing garden waste only please move down to section 2b.

2a Mixed Wastes Only

A single permit is required per site visit, which you hand over to a site operative. You can request a maximum of five permits in any one application. The permit(s) are valid for a 28 day period starting from the date you specify.

* Number of permits required
1 2 3 4 5

* Permit Start Date

* Please describe fully the type of waste or item(s) you want to dispose of.
Please Note: Descriptions such as 'DIY', 'Rubbish' or 'Household Waste' are insufficient:.

If section 2a was completed please move down to section 3.

2b Garden Waste Only

Advance/pre booking

If you are disposing of garden waste only (including leaves, pruning, grass cuttings, branches, trees) you can pre book when you would like to visit the sites. Permits are for one visit each and valid for 28 days.

Example:		Specify required permit start dates:
Permit 1) 5th April		Permit 1)
Permit 2) 5th April		Permit 2)
Permit 3) 5th May		Permit 3)
Permit 4) 5th June		Permit 4)
Permit 5) Not required		Permit 5)

Section 3

* Please tick one centre you wish to use

Annfield Plain	Potterhouse Lane, Pity Me

Broomsdene, Leadgate	Roman Way, Bishop Auckland

Coxhoe, Coxhoe Quarry	Seaham, Strangford Road

Cragwood (nr Cockfield)	Stainton Grove (nr Barnard Castle)

Heighington Lane, Newton Aycliffe	Thornley (nr Shotton Colliery)

Hett Hills, Chester-le-Street	Todhills, Newfield, Bishop Auckland

Horden, Peterlee	Tudhoe, Spennymoor

Middleton in Teesdale

Section 4. Vehicle Details

* Registration

* Make

* Model

* Vehicle Colour

Signage or distinguishing marks if any?

* Is your vehicle hired?
Yes No

If yes please supply name and telephone of company

* Do you intend to use a trailer?
Yes No

If you intend to use a trailer please confirm:

The length (max 3 m)

Number of axles

* Do you require assistance when you visit the site?
Yes No

Section 5 - Terms and Conditions.

I understand that the permit is valid only for me to dispose of my own household waste as described on the permit, at the Household Waste Recycling Centre indicated and for the vehicle stated.

I understand that the permit is not valid for anybody else’s waste or any type of waste not listed on this application.

I understand I must not deposit commercial/trade waste at the Household Waste Recycling Centre. I understand it is a criminal offence for non-household waste to be knowingly deposited at a Household Waste Recycling Centre.

I have read and understand the conditions as stated above.

I confirm that the waste I wish to dispose of is my own household waste. I understand that 1 Tonne is the maximum weight allowed to be tipped per visit.

By submitting this application form I understand that I am accepting the above terms and conditions.

Note: All sections of this form must be completed before a permit will be issued. Failure to do so will result in the application being delayed.

Available in other languages and formats on request.