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Unattended Donation Box Application Permit

  1. Unattended Donation Box Application for Permit

    No permit will be issued until payment has been received in full and processed by the City of Gardner Health Department.

  2. Information on property where box will be placed:

  3. Please include the dimensions of the UDB('s) to be stored on the property

  4. Failure to submit a property sketch depicting the property and the location of the UDB will result in permit denial

  5. Permittee (Property Owner) Information:

  6. PO Boxes must also include street address

  7. Operator Information (UDB Owner):

  8. PO Box Addresses must also be accompanied by a Street Address

  9. Initial

  10. Initial

  11. Initial

  12. Initial

  13. Initial

  14. Initial

  15. Initial

  16. By signing this field, I verify that all of the information that I have provided above is accurate to the best of my knowledge and beliefs.

  17. Payment:

    No permit shall be issued until payment has been received in full and processed by the City of Gardner Health Department. The fee for this permit is $35. Please submit payment made out to "City of Gardner" to Gardner Board of Health, Gardner City Hall Rm 29, 95 Pleasant St. Gardner, MA 01440

  18. Further Information

    The Director of Public Health or designee shall have the right to revoke any permit which he or she may refuse to Issue an initial permit. In addition, the failure of the operator or permittee to comply with the provisions of this regulation or other law shall also constitute grounds for revocation of the permit. The Director or designee shall provide written notification to the Permittee and Operator stating the specific grounds for revocation. Upon revocation, the Unatttended Donation Box shall be removed from the permittee's property within thirty calendar days. If not removed within the time period, the City of Gardner may remove, store, and dispose of any Unattended Donation Box at the permittee's sole cost and expense. Upon revocation, a permittee shall be prohibited from applying for a permit for a period of one year. Any violation of the provisions of this regulation is considered a public nuisance according to M.G.L. Chapter 111, Section 122, and subject to abatement permitted by law. Any person aggrieved by the decision rendered by the director in granting or denying an application for permit under this chapter or in revoking or refusing to renew a permit issued hereunder may appeal the decision to the Board of Health. The appeal shall be made by filling a written notice requesting a hearing thereof not later than ten (10) calendar days after receiving notice of the decision of the Board of Health. The Board of Health shall hold a hearing on the appeal within thirty (30) calendar days and not withstanding other provisions, the decision of the Board of Health shall be final.

  19. Leave This Blank:

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