San Juan County Public Health
             
San Juan County Health Department
735 S 200 W Suite 2, Blanding, Utah 84511
Phone: 435-587-3838
Septic Permit

Owner & Installer Information

Name of Owner:
Owner's Phone Number:
Owner's Email:
Installer's Name:
Installer's Phone Number:

Property Information

Address of Property:
Number of Bedrooms:
Is there a basement?
Yes
No
Is there a well on the property?
Yes
No

Plan Information

*This information will be filled out by the Environmental Health Director. You may leave it blank unless you are certain of the information.
Type of System:
Size of Leach Field:
Size of septic tank:

Soil Testing Information

If you are unaware of the soil testing information you may leave this blank, and our Environmental Health Director will contact you with more information.
Depth of Test Hole (in feet):
Soil Description:
*All systems must be inspected by the Health Department before backfilling. Our Environmental Health Director will contact you shortly. However, if you have any questions feel free to call Dennis Shumway at 435-587-3838 Ext. 3505.
Applicant's E-Signature
Date:

Application Fees

*There will be a travel surcharge of $0.56 per mile round trip (for a total of $1.12 per mile one way) from the San Juan County Administrative Building at 117 South Main, Monticello, UT 84535 for ALL APPLICANTS.
**Please then enter the number of miles to the site of the installation in the quantity box below. This box should ONLY be blank if the location is less than a mile from our office.

For Example, if your inspection is 20 miles from our office please enter "20" in the Travel Surcharge quantity box below.
CLICK HERE to find the mileage from your property to our office for the travel surcharge. This will use your current location if you are at your property. If you are not, please enter your address instead.
Septic Permit:   $300.00   Item Subtotal:  
$300.00
Travel Surcharge:   $1.12   Quantity:   Item Subtotal:  
$0.00
Total:
$300.00
Personal Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Payment Information:
Processing Fee Rates:
Cards:2.5% ($1.50 min)
(1.5% additional service fee for foreign cards)
eCheck:$0.75
Method of Payment:
  Credit/Debit Card
  eCheck
 Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
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