Roswell, GA

Request for Curbside Exemption

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Collection of household garbage and recycling "at the house" in lieu of curbside pickup may be granted at the direction of the Environmental/Public Works Director or his/her designee for senior citizens (age 65 or above) or a medical limitation or disability.

Read the Residential Curbside Exemption Policy

If you have questions about this service, please contact the Solid Waste Division at 770-641-3961 or curbsideexempt@roswellgov.com.

Is a new request or renewal of an existing exemption?

Is a new request or renewal of an existing exemption?

New Request

Renewal

Please select the reason(s) for the curbside exemption request

Please select the reason(s) for the curbside exemption request

Medical Condition/Disability (for applicants under the age of 65)

Senior Citizen

Difficult Driveway

Applicant Information

Applicant Information

Service Address:

Applicant Name:

Applicant Phone:ext.

Applicant Email:

Applicant Date of Birth:

Number of people residing in your household:

List the age(s) of all people residing in your household:

List the date of birth of all people residing in your household:

Property Owner Information

Property Owner Information

Property Owner’s Name:

Property Owner’s Phone:ext.

Proof of Medical Condition/Disability

If applicable, please attach a physician's statement or certification verifying that you are physically unable to take the household garbage and recycling containers to the curb. This is required for applicants under the age of 65.

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Maximum size allowed: 5 MB

Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Proof of Age

If applicable, please proof of age (minimum 65 years old) is required with a driver's license, birth certificate, or other official document showing proof of age; a copy for all people residing in your household is required (No other resident of the household is capable of placing the container curbside for collection)

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Maximum size allowed: 5 MB

Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

Additional attachments can be emailed to curbsideexempt@roswellgov.com.

Service Agreement

Service Agreement

I hereby attest and certify that there is no other resident in my household capable of placing the household garbage or recycling container curbside for collection (initial here):

I agree to be billed the the residential service rate for either standard service (one container) or premium service (two containers) (initial here):

Signature (Please type your full name in lieu of your signature):

Date:

Right of Entry Agreement

Right of Entry Agreement

Property Address:

Name of Owner or Tenant:

Right of Entry: I certify that I am the owner or an owner’s authorized agent of the property described above. I grant, freely and without coercion, the right of access and entry to said property to the City of Roswell Environmental/Public Works Department, Solid Waste Division, including but not limited to each of their agents, contractors and subcontractors solely for the purpose of the removal of residential household garbage and recycling. (initial here):

Hold Harmless: I agree to indemnify and hold harmless the City of Roswell and any of their agents, contractors and subcontractors, for damages, either to the above-described property or to persons situated thereon due to normal activities of collection and removal of wastes as described above. However, damages resulting from actions outside those necessary for waste collection are not waived. No claim for damage shall be paid for any claim waived herein and any other claims shall be submitted to the City of Roswell for review and assessment (initial here):

I forever release, discharge and waive any action, either legal or equitable, that might otherwise arise from the collection of residential garbage and recycling at this location. By signing this document, (I/we) certify that (I/we) (am/are) the owner of this property and/or that (I/we) (am/are) authorized to sign this right of entry and agree to its terms. For the consideration and purposes set forth herein, I hereby acknowledge by my dated signature below (Please type your full name in lieu of your signature):

Date:

The Curbside Exemption must be renewed every two (2) years to ensure accuracy of the program. The applicant will be notified, via phone or in writing, by the Environmental/Public Works Solid Waste Division if the request has been approved or denied within 30 days of receipt of the application.

To receive a copy of your submission, please fill out your email address below and submit.
Email Address