North Hudson Sewerage Authority

NHSA FOG Application

*You must fill out all fields to be able to submit the form.

Applicant Information

Date:
Owner first name:
Owner M.I.:
Owner last name:
Business address:	(street address and unit #)
City, state, and zip code:
Phone:	(Enter 10 digits only, no dashes or parenthesis)
E-mail:
Type of business:

Grease mitigation system information

Type of grease mitigation system (check one from 1 through 4):

1. Indoor               Outdoor
2. Above ground   Below ground
3. Trap                  Interceptor
4. Passive             Automatic

How often is it maintained?
How often is it cleaned?
Name of company maintaining your grease trap:
Size of grease trap:
Number of seats in dining area:
Number of hours open per day:
If applicable, total number of meals served per day:
With or without dishwasher?

Signature

Type your name below on the signature line.

Signature name:

CUSTOMER SERVICE

Report a Sewer Problem