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Refuse Relief Application

Refuse Relief Application
Last updated:

Please fill out the following information to schedule refuse relief! If you prefer a printed copy, you may download a PDF version here and drop it off at the village hall.

Refuse Relief Application
Refuse Relief Application
Name
Name
First Name
Last Name
Address
Address
City
State/Province
Zip/Postal
I hereby make application for temporary stoppage of residential refuse collection services, as follows:
I further understand that the following terms and conditions shall apply to this application:

A. Applicant must be gone a minimum of 2 full months or longer for request of refuse relief. Refuse relief will not be pro-rated, only full months apply.
B. Notify the Village 10 days in advance of the dates that you will be gone and upon return notify the Village that you are home.
C. No exemption shall be granted unless an application based upon this form is submitted to and approved by the Village of Coal Valley, Illinois.
D. Any false information submitted as part of an application shall be cause for the immediate denial of the exemption, and further the prohibition of the applicant from making any further applications with the Village.

Dated this day: 10/11/2025.