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2. If you need a permit for any purpose other than placing a dumpster, roll-off, or other temporary container in county right-of-way, please go to the Right-of-Way Use and Construction Permit page at https://www.jeffco.us/3655/Right-of-Way-Use-Construction-Permit and follow instructions to complete the PDF application form.

4. Description

   A Right-of-Way Use and Construction Permit is required when placing a dumpster, roll-off or other temporary container in public right-of-way. This permit costs $50.00 each plus 2.5% when paying with a credit card.

6. Disclaimer

   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.

8. Applicant Information
10. First Name*
11. Last Name*
12. Company Name (if applicable)
14. Address*
16. City*
17. State*
18. Zip Code*
20. Phone Number*
21. Email Address*
25. Dumpster / Roll-Off / Temporary Container Information
27. Where will the temporary container be placed? Please provide an address / location.*
29. When will the temporary container be at this location?
30. Estimated Start Date*
    Estimated Start Date
31. Estimated End Date*
    Estimated End Date
35. Acknowledgment
    I (we) hereby agree to be bound by the provisions of this Permit under Jefferson County Regulatory Policy 8.3.1, the Jefferson County Transportation Design & Construction Manual, Land Development Regulation and Zoning Resolution, including grading, erosion and sediment controls, and that this Permit shall become invalid, if during the performance of the Work, a violation of the above occurs. Should a violation occur and corrective actions directed by Jefferson County not be performed, I (we) understand this Permit shall be deemed “Cancelled” and the corrective actions performed and/or all improvements removed by a Third Party at the Permit holder’s sole expense.
37. Jefferson County, Colorado and the applicant agree to and approve the use of electronic signatures for purposes of this application and any permit(s) issued pursuant to this application. All use of electronic signatures shall be governed by the Uniform Electronic Transactions Act, C.R.S. §§24‐71.3‐101 to ‐121.
39. Acknowledgment agreement *

    Do you agree to the above acknowledgment?

    1. I agree.
41. Applicant's Electronic Signature*
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field