Tank Removal Fee: Residential $30.00, Commercial/Industrial $60.00
INSP-85 - Rev. 3/2015
TOWN OF HUDSON
FIRE DEPARTMENT - INSPECTIONAL SERVICES DIVISION
12 School Street · Hudson, New Hampshire 03051 · Tel: 603-886-6005 · Fax: 603-594-1142
UNDERGROUND TANK REMOVAL PERMIT APPLICATION
Removal Address: _________________________________________________
Business Name: __________________________________________________
Type of Occupancy: Residential Commercial/Industrial
Estimated Cost: _____________ Permit Fee: _____________
Office Use:
Permit#: _______
Map: _______
Lot: _______
Zone: _______
Scheduled Removal Date: ____________________________ Fuel: Propane Oil
Tank Size: ____________ Number of Tanks: _________ Tank Serial #: __________________________
Removal Company: ___________________________________ Phone #: ____________________
Transporting Company: ___________________________________ Phone #: ____________________
Cleaning/Purging Company: ___________________________________ Phone #: ___________________
Has the tank been prepared in accordance with all applicable standards? Yes
No
Will the tank be cut on-site or transported intact? On-site Transported Intact
Where will the removed tank being transported to? _____________________________________________
Property Owner: ______________________________________ Phone #: ______________________________
Mailing Address:______________________________________________________________________________
Email: _______________________________________________________________________________________
NOTE: An appointment must be scheduled prior to the removal of the tank to arrange for any fire
protection that may be required. The Inspectional Services Division must witness the tank before
the site is filled in and must inspect the tank before it leaves the site.
My signature indicates that the removal for the above mentioned tank is in compliance with all
applicable state and local laws and codes.
_____________________________________________ _________________________
Signature of Responsible Party Date
_____________________________________________ _________________________
Signature of Permit Clerk Date
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