Exemption Form

MANDATORY GARBAGE COLLECTION
EXEMPTION REQUEST FORM

Garbage service is mandatory in Franchise District 3 (generally defined by the area within Placer County east of Donner Summit to Lake Tahoe) if the home or business is occupied in any form during a defined service quarter (Placer County Code Section 8.16.220). If a home/business will be unoccupied for an entire service quarter, this form may be submitted to request an exemption from service for that service quarter.

Property owners must submit this Exemption Request Form to Tahoe Truckee Sierra Disposal within the required timeframe and only for the upcoming quarter; accounts will not be adjusted in arrears. Only one quarter exemption request may be made at a time. Homes/businesses that have been exempted from service will be checked for occupancy; if found occupied in any form, service will start, and the owner will be billed for the entire service quarter.

*If you prefer to print and mail the paper form, click here.

Timeframe to Submit Exemption Request Form	Service Quarter	Dates Home/Business Must be Unoccupied for Service Exemption
November 15 – December 15	First Quarter	January 1 – March 31
February 15 – March 15	Second Quarter	April 1 – June 30
May 15 – June 15	Third Quarter	July 1 – September 30
August 15 – September 15	Fourth Quarter	October 1 – December 31

I acknowledge that my service address may not be used in any form during the service quarter noted above. I understand that if the property is found to be occupied in any form, service will be billed for the entire service quarter.

Service Address

Service Apt/Unit #

Service City

Service State

Service Zip Code

Assessor’s Parcel Number

Owner First Name

Owner Last Name

Mailing Address

Mailing Apt/Unit #

Mailing City

Mailing State

Mailing Zip Code

Contact First Name

Contact Last Name

Contact Phone

Contact Email

If you’re human, leave this empty

Signature:

Owner Signature

Date

*By filling in your name, you agree and acknowledge that:

your application will not be signed in the sense of a traditional paper document,
by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and
you may still be required to provide a traditional signature at a later date.

MANDATORY GARBAGE COLLECTIONEXEMPTION REQUEST FORM

Signature:

MANDATORY GARBAGE COLLECTION
EXEMPTION REQUEST FORM