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SEWER USE APPLICATION

Sewer Use Application

PROPERTY ADDRESS

BUSINESS NAME (If applicable)

BUSINESS ADDRESS (If applicable)

CONTACT PERSON

TELEPHONE NUMBERS OF CONTACT PERSON

CELL Phone

BUSINESS Phone

Signature

BUILDING USE:

RESIDENTIAL

COMMERCIAL

INDUSTRIAL

APARTMENT

COMPLEX

OTHER

Other

If other than residential or apartment complex, please complete below.

What is the nature of your operation?

What type(s) of water will you discharge to the Sanitary Sewer?

Sanitary (Restrooms, etc.)

Cooling Water

Process Water

Scrubber Water

Other

If Other please describe

What type(s) of water will you discharge to the Storm Sewer?

Sanitary (Restrooms, etc.)

Cooling Water

Process Water

Scrubber Water

Other

If Other please describe

Will you discharge any acids, bases or other non-domestic materials?

Yes

No

Will you store any acids, bases or other non-domestic materials?

Yes

No

Will the operation of your facility result in by-products, sludges or residuals?

Yes

No

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