Septic 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. The site plan file must be able to clearly show the required information details when opened. The following information is required to be on the site 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