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2. Notice:

   Applicants must have paid in full for installation of a grease trap that has been inspected, approved, and be located in the City of Fredericksburg (22401) to be eligible for the FOG Improvement Plan. Applicants must attach proof of a paid invoice and passed inspection.

   If you have questions please contact Jamie R. Roberson, Utility Programs Administrator, jrroberson@fredericksburgva.gov or call 540.419.4231.

4. Business Name*
6. Physical Address (must be located in the City of Fredericksburg, zip code 22401)*
8. Mailing Address/P. O. Box
10. City*
11. State*
12. Zip Code*
14. Contact Number*
15. Web Address
17. Applicant Main Contact*
18. Main Contact Title*
20. Main Contact Telephone Number*
21. Main Contact E-Mail Address*
23. Describe the location and size of the grease trap.*
25. Grease Trap Installation Costs*
27. Attach Proof of Paid Invoice
28. Attach Proof of Passed Inspection
30. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Electronic Signature*
33. Date*
    Date

    Date
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit Submit and Print

* indicates a required field