Download this form to coordinate a clean-up in your Dayton neighborhood! Applications are due 3 weeks prior to scheduled event. Submit application via mail, fax, or email to Verletta Jackson Department of Planning and Community Development, City of Dayton 101 W Third Street, 6th Floor Dayton, OH 45402 Verletta.Jackson@daytonohio.gov Fax: 937-333-4281

1. Neighborhood Cleanup Application
DUE THREE WEEKS PRIOR TO SCHEDULED CLEANUP DATE
City of Dayton, Ohio
Dept. of Public Works
Cleanup Location (eg. neighborhood)
Cleanup Date: Cleanup Time:
Applicant Information
Applicant Name: Organization:
Applicant Address: City: State: ZIP:
Applicant Phone: Applicant Email:
Cleanup Information
Number of Volunteers:
Service Locations (see next page for additional space)
Applicant Signature Date
Office Use:
Date
Received:
Date Approved/
Denied:
Approved
Denied
Scheduled Pickup
Date:
Items to be Picked Up - Check All That Apply
Location (Address or Intersection)
Bulk Waste -
Furniture
Bulk Waste -
Metal/Appliances
Yard Waste Tires
Submit application via mail, fax, or email to
Verletta Jackson
Department of Planning and Community Development, City of Dayton
101 W Third Street, 6th Floor, Dayton, OH 45402
Verletta.Jackson@daytonohio.gov
Fax: 937-333-4281
Definitions:
Bulk Waste - appliances, furniture, mattresses, box springs, toys, carpet, and draperies and
like materials normally found in a residential unit. Bulk Waste does not include demolition
matter, infectious waste or hazardous waste.
Yard Waste - trimmings from bushes, shrubs, and trees not exceeding two (2) inches in
diameter or four (4) feet in length, and which are securely packaged or bundled together,
including vegetative matter.
Demolition Matter - those items removed from a structure under construction, repair or
demolition, such as brick, concrete, stone, glass, wallboard, framing and finishing lumber,
roofing materials, plumbing, plumbing fixtures, wiring and insulation material.
DEMOLITION MATTER IS NOT ELIGIBLE FOR PICKUP.
Instructions:
1. Complete application and submit three weeks prior to
event.
2. Wait for notification of approval of event.
3. Contact Montgomery County Solid Waste for supplies
and dumpsters.
4. On the day of event, ensure that there is proper
clearance away from parked cars, garages, over hanging
tree limbs and wires. Bed bug items should be completely
wrapped and sealed before setting out for pick up.
5. Separate items into each specific category.
Household hazardous waste is accepted at Montgomery County Transfer Stations. Visit mcohio.org or call 937-225-4999 for more information.
Notes:
Submit by Email

2. Items to be Picked Up - Check All That Apply
Location (Address or Intersection)
Bulk Waste -
Furniture
Bulk Waste -
Metal/Appliances
Yard Waste Tires