Wytheville, VA · Wythe County
Industrial Pretreatment Permit Application
Businesses that discharge or propose to discharge industrial or non-domestic wastewater to the Town sewer system use this application to provide facility and wastewater information.
What this form is
This application collects information about a facility’s business activities, water supply, sewer connections, wastewater flows, and waste discharge. The Town requires it from permit applicants that currently discharge or propose to discharge industrial or non-domestic wastewater into the Town sewer system. Applicants must submit wastewater analysis results with the application; the form also requests supporting documents in some cases.
Who needs it
A facility owner, partner, or authorized corporate officer completes and certifies this application when the facility discharges or plans to discharge industrial or non-domestic wastewater to the Town sewer system.
How to submit it
Return the completed application and wastewater analytical results to the Town of Wytheville, P. O. Box 533, Wytheville, VA 24382-0533, Attn: Scottie Davis, Pretreatment Administrator. The document states that a $100.00 application fee must accompany the submission.
About notarization
This application is signed and certified without a notary; the document requests wastewater analytical results and, when applicable, operator documents and chemical safety data sheets.
How to submit this form
- 1
Download the Application
Download the Industrial Pretreatment Permit Application PDF.
- 2
Complete the Application
Answer all questions truthfully and completely; use “Not Applicable” or “NA” when a question does not apply.
- 3
Gather Required Materials
Include wastewater analytical results and any applicable operator documents and current chemical safety data sheets.
- 4
Sign and Submit
Have an eligible facility representative sign and certify the application. Send it with the stated $100.00 fee and analytical results to the address in the instructions.
Frequently asked questions
- Do I need a notary for the Industrial Pretreatment Permit Application?
- No. The application requires certification and a signature from the facility owner, a partner, or an authorized corporate officer, but it has no notary block.
- How do I submit the Industrial Pretreatment Permit Application?
- Send the completed application and wastewater analytical results to the Town of Wytheville, P. O. Box 533, Wytheville, VA 24382-0533, Attn: Scottie Davis, Pretreatment Administrator. Include the stated $100.00 fee.
- What attachments does the application request?
- Submit wastewater analytical results. If the operator is different from the owner, the application requests a copy of the contract or other documents describing the operator’s responsibility. It also asks for current safety data sheets for identified chemicals.
- Who must sign and certify the application?
- The application must be signed and certified by the facility owner, a partner, or a corporate officer authorized to represent the permit applicant.