* Required Field
Business Information
Business Name
*
Business Physical Address
Business Mailing Address
Business Owner's Name:
Salutation
*
Mr.
Ms.
Does the business owner own the property/building?
*
Yes
No
Property Owner's Name
Property Owner's Mailing Address
Is this business designated as a corporation?
*
Yes
No
Corporation Information:
Corporation Mailing Address:
Facility Information
Hours of Operation
*
Specify each day, i.e. M-TR 8a to 10p, FR and SA 10a to 12a, SU Closed
Which of the following will be prepared or served at this facility? (Mark all that apply)
*
Food Prep Only
Drinks Only
Snacks
Breakfast
Lunch
Dinner
What is this facility's seating capacity?
*
0 (no customer seating)
1-10
11-25
26-50
51-100
101-250
Over 250
How many kitchens does this facility contain?
*
How many of each of the following types of equipment are or will be installed at this facility (not including the restrooms)?
Enter a zero if none:
Provide the dimensions (in inches) of one of the triple sink tub sections (the part that holds water):
Depth (From sink drain up to top of tub wall)
Width (Side tub wall to side tub wall)
Length (Front tub wall to back tub wall)
Will a dishwasher be used within this facility?
*
Yes
No
Provide the following information for each dishwasher
Dishwasher: Gallons of water discharged per cycle
Dishwasher: Average racks/cycles per day that are or will be put through the dishwasher
Do any of the following describe the primary operations of this facility?
*
A restaurant that prepares meals
A cafeteria/buffet
A school
A food production facility
A grocery store deli
A bar with a food menu
Yes
No
Will this facility only serve pre-packaged food that is prepared and cooked at a different facility?
*
Yes
No
Will this facility only serve food on disposable packaging with disposable utensils?
*
Yes
No
Will this facility only serve frozen, cold, room temperature, warmed, toasted and/or catered in food? If cooking or frying will occur on-site, answer No.
*
Yes
No
Will this facility prepare or serve food that is cooked or fried on-site?
*
Yes
No
Will this facility only offer delivery and/or take out service and there is no dine-in or dine-on premises seating?
*
Yes
No
Are any chemical or biological additives used on a constant, regular, or scheduled-basis (excluding dishwashing soaps/detergents)?
*
Yes
No
Does this facility have an existing grease trap and/or interceptor?
*
Yes
No
Grease Control Equipment
Provide the following for each piece of existing grease control equipment:
Equipment #1: Location (i.e., under the triple sink)
Equipment #1: Capacity Size (enter a number)
Equipment #1: Capacity Units
gal.
lbs.
Equipment #1: Manufacturer
Equipment #1: Measurement of trap in inches (length x width x height)
Equipment #2: Location (i.e., under the triple sink)
Equipment #2: Capacity Size (enter a number)
Equipment #2: Capacity Units
gal.
lbs.
Equipment #2: Manufacturer
Equipment #2: Measurement of trap in inches (length x width x height)
Any Additional Grease Control Equipment Comments
Application Submittal
Type your name as an Electronic Signature
*
Title/Relationship to Food Service Facility
*
By checking this box and submitting this application form, I certify that I am, or have been authorized by the business and/or property owner, to sign this document and acknowledge that I have read KUB's Grease Control Program. I also understand that if the facility is remodeled or there is a change in ownership of the business, I must immediately submit to KUB in writing such changes or possibly be in violation of my Grease Control Permit, which is nontransferable. I am aware that there are penalties for submitting false information, including the possibility of enforcement actions in accordance with KUB's Rules and Regulations for the Wastewater Division, KUB's Grease Control Program and its associated Enforcement Response Guide.
My electronic signature above indicates that I am the person responsible for ensuring that the business listed on this Grease Control Permit Application is compliant with KUB's Rules and Regulations for the Wastewater Division and KUB's Grease Control Program. I agree that the business listed on this Grease Control Permit Application will abide by all applicable provisions of KUB's Rules and Regulations for the Wastewater Division and understand that failure to do so may cause disconnection of water service or other enforcement actions in accordance with the Grease Control Program Enforcement Response Guide. I also understand that I am responsible for the grease control equipment and meeting the requirements of the Grease Control Program, even if I do not own the property.
NOTICE: Failure of the responsible party for the business listed on this Grease Control Permit Application to sign this application does not relieve the business from any compliance requirements of KUB's Rules and Regulations for the Wastewater Division or KUB's Grease Control Program.
I agree
Additional Comments