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Application For Approval To Construct A Subsurface Sewage Disposal System

  1. Application is hereby made for a permit to construct a sewage disposal system for a:*
  2. Type of Request*
  3. 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.
  4. (Owner or duly authorized representative)
  5. General Information
  6. Office Use Only
  7. Print Name
  8. Note: Approvals to construct can only be issued by the Local Director of Health or Registered Sanitarian
  9. Leave This Blank:

  10. This field is not part of the form submission.