NHSA Customer Services window

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):

                                                 

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

Customer Flood Mitigation Program

Low-Income Household Water Assistance Program

FOG

Mailing Address for Sewer Payments

Pay Bill Online

Paperless Billing

Address Changes

Billing

Facilities Charge Exemption

 

 

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