Fillable COUNTY FULTON COMMERCIAL WASTE DISCHARGE PERMIT APPLICATION (Fulton County Government)

Fill Online, Printable, Fillable, Blank COUNTY FULTON COMMERCIAL WASTE DISCHARGE PERMIT APPLICATION (Fulton County Government) Form

Use Fill to complete blank online FULTON COUNTY GOVERNMENT (GA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

COUNTY FULTON COMMERCIAL WASTE DISCHARGE PERMIT APPLICATION (Fulton County Government)

On average this form takes 19 minutes to complete

The COUNTY FULTON COMMERCIAL WASTE DISCHARGE PERMIT APPLICATION (Fulton County Government) form is 2 pages long and contains:

  • 0 signatures
  • 9 check-boxes
  • 73 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Fulton County Government

BROWSE FULTON COUNTY GOVERNMENT (GA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
(Revised 10/23/18)
FULTON
COUNTY
COMMERCIAL WASTE DISCHARGE PERMIT APPLICATION
Commercial Pretreatment, Department of Public Works
11575 Maxwell Road,
Alpharetta, Georgia 30009
Telephone: : 404-612-9425
Fax: 404-224-1197
COMMERCIAL WASTE DISCHARGE PERMIT APPLICATION (Revised 09/28/16)
Page 1 of 3
PERMIT NO. __________
OFFICIAL USE
DATE: ______________
New
Existing
1. FACILITY INFORMATION:
NAME OF FACILITY: ___________________________
TELEPHONE NO: ______________________ EXT. ______
FACILITY CONTACT: ____________________
FAX NO: _________________________________
ADDRESS: ________________________________________________________________________________
TOWN/CITY: ____________________________________ STATE: _____________ ZIP CODE: ____________
EMAIL: _________________________________________
MAILING ADDRESS: (if different from above)
ADDRESS: ________________________________________________________________________________
TOWN/CITY: ____________________________________ STATE: _____________ ZIP CODE: ____________
EMAIL: _________________________________________
OWNER/CORPORATE INFORMATION:
NAME:____________________________ CONTACT NAME: ________________________ TITLE: _________
TELEPHONE NO:______________________________ EXT. _________ FAX NO: ______________________
ADDRESS: ________________________________________________________________________________
TOWN/CITY: ____________________________________ STATE: _____________ ZIP CODE: ____________
2. COMMERCIAL WASTE PRETREATMENT SYSTEM:
Grease Trap
Oil Separator
Sand Trap
System Location: exterior
interior
Tank Capacity ________ (exterior)
Pumping Frequency ____________________________
Type of system (s) _
___________, __________________
Flow Rate /lbs. ____/____ (interior) Number of systems______
3. TYPE of BUSINESS: (restaurant, school, car maintenance.)________________________________________
Any new kitchen equipment added since business opened? YES / NO
(if yes, fill out equipment list if the grease trap is on the interior of business)
List any previous names of business, if business is less than (2) years old.
1
. ________________________ 2.________________________ 3.________________________
What county or city provides your water and sewer? (If your utilities are provided by one jurisdiction, select # 3
and list county or city)
1. WATER __________________ 2. SEWER__________________ 3. WATER & SEWER __________________
4. COMMERCIAL WASTE TRANSPORTER SERVICE: F.O.G. Permit # ___________________
__________________________________ ________________________________
ADDRESS: ________________________________________________________________________________
TOWN/CITY: ____________________________________ STATE: _____________ ZIP CODE: ____________
TELEPHONE No: ___________________ Ext. _____________ Fax No: ____________________
Company Name
Company Contact
5. GREASE/WASTE OIL RECYCLE COMPANY:
__________________________________ ________________________________
Company Name
Company Contact
ADDRESS: ________________________________________________________________________________
TOWN/CITY: ____________________________________ STATE: _____________ ZIP CODE: ____________
TELEPHONE No: ___________________ Ext. _____________ Fax No: ____________________
How often is recycled grease /oil waste removed? ________________ Container Capacity _____________
I certify under penalty of law that this document and all attachments were prepared under my direction or
supervision in accordance with a system to ensure that the information submitted with the best of my knowledge
and belief, is true, accurate and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of citations, fines or imprisonment for known violations.
_____________________________________
Print Name
_____________________________________
Title
___________________________________________
Signature
_______________
Date
ADDRESS: __________________________________________TELEPHONE NO: ___________________
Registered Agent: (if applicable)
____________________________________________________________________________
OFFICE USE ONLY
PERMIT FEE $ ______________________
DATE REC’D: _______________________
PERMIT EXPIRATION DATE: _______________
CHECK NO: ____________________________
The permit fee is determined by the type and number of pretreatment systems the generator has on site as stated
in County records. County records are updated annually. If a commercial waste generator disagrees with their
permit fee assessment, they can request a site inspection by the County for a fee of $50.00. The $50.00 fee will not
be deducted from the annual permit cost. Permit fees are due March 31
st
of each year, with a 25% penalty
occurring after March 31
st
.
COMMERCIAL WASTE DISCHARGE PERMIT APPLICATION (Revised 09/28/16)
Page 2 of 3
INSTRUCTIONS FOR COMMERCIAL WASTEWATER PERMIT APPLICATION
1. Commercial wastewater application must be filled out by owner or Georgia registered agent of the
commercial or industrial business.
2. SECTION - 1
Facility Information - name of the facility; contact name for facility, such as owner, operating manager
or designated personnel for facility location.
Mailing Address - state SAME if all mail and important documents are sent to the facility location.
Owner/Corporate Information - owner or corporation responsible for store. Do not list the business
address or telephone number as owner /corporate information unless this is the corporate location. If
the business is owned by a single person, then home address and telephone will be listed here. If the
business is owned by a corporation, then list corporate address, contact, and telephone.
3. SECTION - 2
Commercial Waste Pretreatment System – fill in all information that applies to the type of system that
is installed in business
4. SECTION - 3 - state type of business such as restaurant, church, car/truck wash, school, grocery store,
etc. List any previous restaurant names if known and indicate provider of water and sewer service.
Facilities with interior grease traps only, if additional equipment has been added or renovation has
occurred, list new equipment on separate sheet of paper.
5. SECTION - 4
Commercial Transporter Service – the pumping company that cleans the grease trap or oil
separator. The transporter must have a FOG permit number and it must be listed in this section.
Request that information from the transporter you select for service.
6. SECTION - 5
Grease or Waste Oil Recycle Company – food service facilities will list the company that picks up their
fryer grease or waste oil. Car maintenance shops will list the company that picks up their used waste oil
from oil changes. If the recycle company is the same vendor that cleans or maintains your grease trap or
oil separator, just state SAME in this section.
7. Print name and title, sign and date the commercial waste application once you have completed the
form. Make sure you read the statement to provide accurate information when completing the
commercial wastewater application. The application must be signed by the owner of the business or
the registered business agent. The business agent must be registered in the state of Georgia. Any
applications signed by the registered agent must provide the agents address, telephone number; no
P.O. Box addresses are allowed. All signatures must be original and signed in blue ink. No faxed or
computer generated signatures will be accepted. Please be advised this is a legal document. Keep a
copy for your records
8. If the commercial wastewater application form is not filled out correctly, it will be returned. No permit
will be issued without completing the application. All payments must be in the form of a check or
money order and made payable to Fulton County Department of Public Works.
COMMERCIAL WASTE DISCHARGE PERMIT APPLICATION (Revised 09/28/16)
Page 3 of 3
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

COUNTY FULTON COMMERCIAL WASTE DISCHARGE PERMIT APPLICATION (Fulton County Government)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 6 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document