2. Permit Application

   Septage/Grease Hauler

   Fee: $50.00

4. Company Name*
5. Applicant Name*
7. Phone Number*
8. Cell Phone Number
10. Email Address*
12. Address
14. City
15. State
16. Zip Code
18. Please list DBAs ("Doing Business As") Names
20. Name
21. Name
22. Name
24. Please list MA DEP authorized location(s) where septage/grease will be disposed
26. Location*
27. Location
29. Please include the following:
31. • Workers’ Compensation Insurance Affidavit form
32. Workers Comp Upload*
34. • Copies of the contract(s) or approval(s) for use of disposal locations
35. Disposal Document Upload*
37. • $50 Application Payment

38. You can pay this fee on our website through "Online Payments" or by check made out to "Town of Burlington" and mailed to: Burlington Board of Health 61 Center Street Burlington, MA 01803

40. Certification*

    I certify that the information I have provided is true and accurate.  I recognize that it is a violation of the permit to dispose of septage or grease anywhere other than the identified disposal locations or others approved by the Board of Health in writing as an amendment to this permit.

    1. I have read and agree to the terms above
42. Signature of Applicant*

    This is an electronic signature to submit your application, there is no need to print or download this form for a physical signature.

43. Date*
    Date
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit Submit and Print

* indicates a required field