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 Ronnie Nieves at 435-587-3838 Ext. 3505.
Applicant's E-Signature
Date:

Application Fees

*There will be a travel surcharge of $0.56 per mile if the inspection is more than 15 miles from Blanding or Monticello.
**If this applies to you, please enter the number of miles from Blanding or Monticello (whichever is closer) in the quantity box below. Please do not enter anything if you are less than 15 miles from either Blanding or Monticello.
For Example, if your inspection is 20 miles from Monticello please enter "20" in the quantity box below.
Septic Permit:   $300.00   Item Subtotal:  
$300.00
Travel Surcharge:   $0.56   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)
(4% for foreign cards)
eCheck (ACH): $0.75
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
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