Holding Tank Permit Application

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Holding Tank Permit Application

Applicant Name*

Address*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Applicant Phone Number*

Phone Area Code-Phone 3-Phone 4 ext Extension

Applicant Email Address*

Address Where Holding Tank Will Be Installed*

Installer Name*

Installer Phone Number*

Phone Area Code-Phone 3-Phone 4 ext Extension

Septic Tank Size and Manufacturer*

Pump Alarm Information- Manufacturer and Model Number*

*** Provide a written contract with a septage management vehicle operator for regular removal of septage from the tank. *** Records of removal of septage may be required by the Health Department.

By checking this box, you acknowledge that failure to follow these guidelines may result in revocation of the holding tank permit.*

Yes

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Holding Tank Permit Application

Holding Tank Permit Application

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