Waste Wood Request Form

City of Racine Forestry Division

WASTE WOOD REQUEST City of Racine Residents: Please be advised of the following ordinance governing firewood storage. Sec. 42-32. Storage of firewood. (a) No person shall store firewood unless it is stored in a straight, orderly pile which is raised a minimum of six inches off the ground, and is not more than six feet high. (b) No person shall place or store firewood in the front yard as defined in section 114-1, and not closer than four feet to a dwelling unit.

Completed Request Form & Payment to be Returned to: PRCS, 800 Center St. Rm. 127, Racine 53403 PLEASE NOTE - Quantities are limited. Contact PRCS at 262.636.9131 before sending payment to ensure applications are still being accepted.

Requestor (Property Owner)

First/Last Name: Home Phone: Cell Phone:

Street Address: City: St: Zip:

Email Address:

The undersigned Requestor offers to receive waste wood from the City of Racine and acknowledges and agrees to the following terms and conditions: 1) Fee. A $75.00 delivery fee (plus tax of $3.83) must be paid at the time of the request, prior to the delivery of waste wood. Fee is non-refundable unless your request is denied, in which case a 100% refund will be issued. 2) Payment methods. Mastercard, VISA, cash or check will be accepted. Make checks payable to PRCS. Payments must be mailed with this form or made in person at 800 Center St., Rm. 127, Racine, WI 53403. 3) Requests. Requests are on a first-come first-served basis. A limited quantity of requests will be accepted. 4) Definition. Waste wood is defined as tree stems and branches of irregular size, shape and condition and comprised of various species which may be used for firewood, saw logs or landscaping purposes. Waste wood is uncut and un-split. Waste wood will vary in size from 12" in diameter to 60+" in diameter. Waste wood may contain hollows and be in various stages of decay. 5) Quantity. Loads are based upon 20' L x 8' W x 4 'H (640 cu. ft.) dump box, which is approximately 5 cords. The actual amount received may be more or less than five cords. The waste wood will not be bundled, grouped or secured in sections in any way, and City of Racine does not warrant its suitability for any purpose whatsoever. 6) Delivery. Once the payment and this form are received, your request will be added to a list and delivered according to the date the order was received at PRCS: Forestry Division Staff will attempt to contact you by telephone prior to delivery, but may proceed with delivery regardless of actual notice to Requestor. Delivery area is Racine County, east of Highway 45. The undersigned Requestor hereby agrees to comply with local ordinances governing firewood use and storage.

******** 7) Hold Harmless. Requestor understands and agrees that it is obtaining the waste wood in an as-is condition and City of Racine makes no representation or warranty of the suitability of the waste wood for any use or purpose whatsoever. In consideration for the waste wood received or to be received hereunder the Requestor hereby covenants NOT TO SUE and further holds harmless the City of Racine, its departments, officers, employees and agents from and against any and all property damage, bodily injury or any other type of damage or loss whatsoever arising out of the delivery, or provision of waste wood to Requestor as described herein. Requestor is aware that damages to property may result from weight of the truck used for delivery of the waste wood, or the act of dumping, including the rolling and/or bouncing of individual pieces which may strike nearby objects or persons. ******** 8) Access. The truck requires an 11' wide and 14' high access to area where wood is to be dumped. Truck weight when fully loaded is approximately 46,500 lbs. and may damage sidewalk, turf, etc. Requestor is solely responsible for identifying the dump area, clearing the path for the truck to access the dump area, and clearing the dump area to prevent damage to persons or property.

Owner's Signature Required: Owner's Signature Print Name Date

FORESTRY DIVISION USE ONLY

Order Date Date Delivered

Delivered By PLEASE DRAW A MAP of the residence/property & indicate the EXACT LOCATION where you would like to have the wood dumped. Please be detailed. Include streets, driveway, etc.

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