Application for Clean Up Collection
Address: 48 Longueville Rd, Lane Cove Postal Address: PO Box 20, Lane Cove 1595
Tel: (02) 9911 3555 Fax: (02) 9911 3600 Web: lanecove.nsw.gov.au Email: lccouncil@lanecove.nsw.gov.au
Applicant
(to be completed by
applicant)
Name of Property Owner or Managing Agent: …………………………………………….
Property address: ……………………………………………………………………………
Business name *(if applicable): ……………………………………………………………..
Delivery address:…………………………………………………………………………...
Contact No: ………………………………
Fees
$225.00
Dates
Preference (1)……………………………. or
Preference (2): ……………………………
Type of Items
Accepted
Furniture
Soft furnishings
Blinds
Broken toys
Whitegoods, metal & small appliances (with
doors removed) **
Items must be lifted by max. two persons
Maximum of 3m3 (approx. one small trailer
load)***
Conditions of
Consent
Declaration by
Applicant
Mobile: …………..……………….
Green Waste
Recyclable materials, such as
cardboard boxes
Paint tins, chemicals or gas
cylinders
Building materials (including
baths, bricks, stones, guttering,
wire and metal framing)
Car parts, tyres, commercial
waste
# Please refer Council’s website for a complete list
1. All applications must be accompanied by an up front payment.
2. The general clean-up items must be presented to the nature-strip for
collection only on the night before your booked collection day.
3. Any unacceptable clean up items will not be collected
4. Fines will apply if excess/unaccepted items are left after collection day.
Excess items must be cleared from nature strip the same day.
5. The fees & charges quoted are subject to change each financial year
6. *The business requesting the service must be an existing Council waste
collection customer.
7. ** Please place in a separate pile.
8. ***The contractors will not collect the items outside the 3m3 limit. i.e., only 3m3
of Clean Up items will be collected, the rest will be the responsibility of
residents/owners of property.
I understand and accept the Conditions of Consent and that I am the “Authorised”
person to execute the request for additional waste bin service.
………………………………………………………
Signature of resident
…………………….
Date
Payment form over 1 of 2
* Fees are based on financial Year 2015/2016
TRIM 36057/15
Privacy
Cardholder Details
Under the Privacy or Personal Information Protection Act (PPIPA), Council is
required to advise you that personal information being collected from you in relation
to this matter will only be used for the lawful and proper functions of Council. Any
such use will be in accordance with this Act and its associated Management Plan
and Codes.
Name on Card: ………………………………………………………………………
Address (if different from above): ……………………..……………………………
Suburb (if different from above): ………………
Postcode:…………..
Contact Numbers ( if different from above):
Card Details
 MasterCard
(We DO NOT
accept Amex or
Card No:
Diners Club Cards)
 VISA
   
Expiry date: /
Payment Amount:
………………………………………………
Signature of Cardholder


Office Use Only
(T337)
$
………………………..
Date
Please note that this payment is subject to approval of funds by your financial
institution.
A 1% fee (incl.GST) is applicable to all credit card payments
URM
notified
Yes
No
Processed by
Completed by
Comments if disapproved:
2 of 2
* Fees are based on financial Year 2015/2016
TRIM 36057/15