Septic Permit Application

FORM – English

    Required Contact Information




    SEPTIC SYSTEM PERMIT APPLICATION






    ***The following questions are not applicable if only applying for a renewable operating permit***

    What is the anticipated depth of the lowest floor below natural grade:

    Will the building have:
    Basement
    Crawlspace
    Slab on grade

    If residential, how many bedrooms will the home have (unfinished basement = 1 additional bedroom):

    If commercial, what is the anticipated maximum daily wastewater flow (gallons per day):

    If a public water system is to be used, has a connection been approved for the proposed building:

    If a private well/spring is to be used, what is the water right number or date right was applied for:

    *Please attach a PDF building site plan that is drawn to scale and a minimum of 11” x 17”. The
    following information is required to be on the plan:

    1. Complete address, Parcel identification number, Owner, and Date plans were drawn
    2. North Arrow
    3. Property line boundaries
    4. Access to property from point of connection with publicly maintained road(s)
    5. Ground surface contours (topographical) or slope direction/percent arrows
    6. Location and explanation of type of dwelling or structure to be served by the septic system
    7. Location of utility lines or service points of connection (water, electrical, gas, propane tanks)
    8. Location of all intermittent or year-round streams, ditches, watercourses, ponds, subsurface
      drains, etc.
    9. Location of all existing and proposed water supply sources. Also include the location of existing
      and proposed water supply sources on neighboring properties within 200 feet of the proposed
      septic system area
    10. A general location of the proposed/preferred septic system area and 100% replacement area
    11. If public drinking water source protection zone two area(s) are located on the parcel, show the
      area(s)
    12. If the property is located within a sewer service boundary, show the location and distance to
      nearest sewer
    13. Show any existing easements
    14. Show existing structures

    Max File Size: 2MB

    Or for larger files provide a public link to DropBox, or GoogleDrive, so that we can download your files:

    Application Signature

    I certify that the information given is true and correct to the best of my knowledge

    Septic Fees

    The permit fee total does not include fees for alternative technology septic permits and/or non-residential uses. Please see the septic permit instructions for fee amounts. Fee payments can be made over the phone by calling 435-792-6570.

    Click the SEND button only once. It will take just a moment to process your information. You will receive a confirmation email if your submission was successful.