Authorized Representative Statement:
I certify that I have received and read the FOG Ordinance of the City of West Columbia and I understand
that all food service establishments must have compliant grease removal devices installed and in proper
working order prior to discharging into the City of West Columbia sanitary sewer system.
I further certify that, to the best of my knowledge and belief, this application contains accurate
information about my facility and that it was completed under my direction and with my approval. I am
aware that providing false information or violating the aforementioned specifications could result in
termination of my water and/or sewer service and revocation of my permitted water and/or sewer
capacity for this facility.
I also understand that if my water and/or sewer service is terminated or my registration is revoked that I
will have to re-pay and/or re-apply for water and sewer service with the City of West Columbia.
Print Name: ___________________________________________________________________________
Title:_________________________________________________________________________________
Signature________________________________________ Date:_____________________
Return this application (within 30 days)
Andy Zaengle, Director of Engineering and Water Plants
PO BOX 4044 West Columbia, SC 29171-4044
FOR OFFICIAL CITY USE ONLY:
Application complete: _____Yes _____No
Date of pre-permit inspection; ___________
Registration to be Approved ( )
Denied ( ) - Explanation for Denial:__________________________________________
_________________________________________________________________________
_________________________________________________________________________
Date:_____________________ Application Reviewer: _____________________________
REGISTRATION NUMBER:_______________________
Department of Engineering and Water Plants
Wastewater Compliance
Fats, Oils and Grease Registration Packet Application