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2. In accordance with the City of Elk River Solid Waste Ordinance, door-side service will be provided by the hauler at the direction of the City Administrator or his/her designee for elderly and disabled customers. Residents in need of the door-side service shall apply for the service and provide justification for the added service. Determination by the City Administrator or his/her designee is final. Customers approved for door-side service shall indemnify both the hauler and the city for any damages to the residential or personal property or persons as a result of the service. Carts in need of door-side pick-up shall be easily accessible for the hauler and shall be placed in front of the garage or parking stall. The hauler shall not be required to enter through the garage, fences, or other containments.
4. Name*
6. Date*
   Date
8. Phone Number*
10. Address*
12. Contact Info (phone or email)*
14. Justification for Door- Side Service*
16. Instructions for the hauler (bin location, etc.)
18. Applicant agrees to indemnify the hauler and the City for any damages to applicant’s residential or personal property or injury to persons as a result of Applicant receiving door-side Service.*
    Applicant Signature
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20. 1. Receive an email copy of this form.
21. Email address

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22. Submit

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