Request A Grit Bin

Title

First Name

Last Name

Email Address

Contact Telephone Number

Address

Postcode

Is this Request being made on behalf of an Organisation

Organisation Name

Organisation Address

Postcode

Please include Street Name and Town

Please choose the nearest Town

Specific Location i.e. at the side of number 23

Sketch or Photograph

Please include a sketch or photograph of the specific location

Is the proposed location on a steep gradient?

Yes No

Is the proposed location on the public footway greater than 1.3 metres wide?

Yes No

Is the proposed location on a public road?

Yes No

Is the proposed location near a junction that would obstruct driver’s sight lines?

Yes No

Is the proposed location more than 200m from nearest grit bin?

Yes No

Is the proposed location within an urban area?

Yes No

I confirm that I have read and understood the Grit Bin policy and Guidance notes relevant to this application.

First Name

Last Name

Grit Bin Application Form