城市排水许可申请表(空).pdf

学习文档仅供参考申请编号：受理编号：申请时间：受理时间：城镇污水排入排水管网许可申请表申请单位章中山市腾格电子排水户中山市腾格电子填 表 日 期申 请 类 别：首次申请 变更申请 延期申请学习文档仅供参考填写说明1、本表一式两份，申请人一份，归档一份。2、表格使用黑色钢笔或签字笔填写，也可用电脑打印，字迹工整，不得涂改，申请表封面应加盖申请单位公章。3、本表“一、基本情况”和“二、排水管网情况”、“三、排水水质情况”的内容由排水户申请单位真实、准确、完整、全面地填写。“申请编号”、“申请时间”、“受理编号”、“受理时间”等内容由发证机关填写。4、本表一律用中文填写，数字均使用阿拉伯数字。5、本表封面的“申请类别”一栏，申请人如果是首次申请，请在“首次申请”后的方括号内打勾；如果是由于排水口数量和位置、排水量、污染物项目或浓度等许可内容变更重新申请，请在“变更申请”后的方括号内打勾；如果是延期申请，请在“延期申请”后的方括号内打勾。“基本情况”部分“用水量”、“排水量”需提供相关依据，“污水预处理方式”如是委托处理，在相应的方框内打勾即可，如是自行处理，还需注明污水处理工艺。6、“排水管网情况”需填写所有排水口设置情况，雨水排放口不需要填写“排水量”及“有无在线监测装置及检测项目类型”项。7、“排水水质情况”应按照由具有计量认证资质的排水监测机构出具的排水水质检测报告填写；拟排放污水的新排水户应附水质、水量预测报告。8、本表在填写时如需加页，一律使用A4 型纸。9、复印件需加盖公章或法人签名。文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 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ZC3S9X7Z10S3学习文档仅供参考三、排水水质情况参照污水排入城镇下水道水质标准的项目排水口编号项目名称浓度mg/L 项目名称浓度mg/L 备注：注：1、排水户存在多个排放口的，应按排水口编号分别填写各个排水口的水质情况。2、雨水排水口可不填。文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 ZC3S9X7Z10S3文档编码:CG1R4P2R9B9 HU8J2X2Q5R7 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