Skip to form

Tyler Alexander Water/Sewer Compliance Specialist

PO Box 1748 Gastonia, NC 28053



Food Service Establishment Permit Application

This form is to be completed by an Authorized official of your firm, as defined in the Sewer Use Ordinance. 

An Authorized official is defined as a person responisble for the principle business decisions of other policy decisions for the facility. 

Failure to submit this form may result in enforcement action in accordance with the City of Gastonia/Two Rivers Utilities and Industrial Wastewater Pretreatment Ordinance.

Section I

Contact Information

Business Physical Address

    Owner Mailing Address

      Does your food establishment have a connection with the City of Gastonia/Two Rivers Utilities Sewer System?

      Section II

      Food Service Establishment Information

      What meals do you serve? (Select all applicable)

      Is your establishment used as the base location for any mobile food service units?

      How do you classify your establishment? (Please check all that apply)

      What menu item(s) does your establishment serve? (Please check all that apply)

      Is disposable serving ware used?

      Section III

      Used Fryer Oil

      Will you be using fryer equipment?

      Is an Outdoor Recycle Bin or Internal Tank & Pump System used?

      Grease Trap and/or Interceptor

      How often is it cleaned out?

      What date was it last cleaned?

      Date Picker

      Where is the Grease Trap and/or Interceptor located? (If you were facing the front of the establishment)

      Section IV

      Commercial Plumbing Fixtures

      Please select the number of each of the following kitchen wastewater sources (please do not include bathroom fixtures):

      Section V

      Kitchen Equipment

      Please select the number of each of the following pieces of equipment:

      Section V

      Bio-remediation Technology

      Is bio-remediation technology (liquid or powdered bugs or enzymes) practiced and added to the drainage system, Grease Trap/Interceptor, or to any wastewater discharged to the City sewer system?