Commercial Waste Discharge Permit Application Form

Water & Sewer
2757 East Point Street
East Point, GA 30344

Office: (404) 669-4313 or 404-270-7189

Fax: (404) 765-1014
Email: Water_Sewer@EastPointCity.org

Commercial Waste Discharge Permit Application
*Please return this form via email, fax or mail to: Water & Sewer (see above).

BUSINESS INFORMATION

New or Existing*

NewExisting

Name of Facility:*

Contact Person:*

Full Name

Address:*

Telephone:*

Email:*

OWNER/CORPORATE INFORMATION

(if diferent from above)

Contact Person:

Full Name

Telephone:

Address:

PRE-TREATMENT SYSTEM TYPE

Choose all that apply:*

Grease TrapOil SeparatorSand/Grit Trap

Tank Capacity (exterior): *

Pumping Frequency:*

Interior Trap: *

Number of System(s)*

WASTE HAULER INFORMATION

Company Name:*

Contact Person:*

Full Name

Address:*

I certify under penalty of law that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel gather and evaluate the information submitted. Based on my inquiry of the person or persons directly responsible for gathering the information, the information is, to the best of my knowledge and belief, 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:*

Today's Date:

MonthDayYear

Signature:*

Mission Statement
To provide exceptional city services in the most professional, courteous and effective manner to enhance the quality of life in the City of East Point.

FOR OFFICIAL USE ONLY

Permit Fee:

Date:

MonthDayYear

The permit fee is determined by the type and number of pretreatment system(s) the generator has on site as stated in the City records. City records are updated annually. If a commercial waste generator disagrees with their permit fee assessment, they can request a site inspection by the City for a fee of $50.00. The fee WILL NOT be deducted from the annual permit cost. Permit fees are due by March 31 of each year, with a 25% penalty occurring after March 31.