San Juan County Health Department
735 S 200 W Suite 2, Blanding, Utah 84511
Owner & Installer Information
Name of Owner:
Owner's Phone Number:
Installer's Phone Number:
Address of Property:
Number of Bedrooms:
Is there a basement?
Is there a well on the property?
*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):
*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 Ronnie Nieves at 435-587-3838 Ext. 3505.
*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 Public Health office in Blanding for ALL APPLICANTS.
**Please enter the number of miles from our office in Blanding 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.
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.
Processing Fee Rates:
2.5% ($1.50 min)
(1.5% surcharge for foreign cards)
Method of Payment:
Update Name from Personal/Organizational Information
Name on Account:
Name on Card:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
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