San Juan County Public Health
             
San Juan County Health Department
735 S 200 W Suite 2, Blanding, UT 84511
Phone: (435) 587-3838
Recertification For Well / Septic
Date
Home Owner's Name
Location of Home
Contact Phone Number
Contact Person if different than owner
Approval letter to go to the following:
Establishment Information
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
 
Select Requested Services
*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 Recertification:   $75.00   Select:   Item Subtotal:  
$0.00
Well Recertification:   $75.00   Select:   Item Subtotal:  
$0.00
Travel Surcharge:   $1.12   Quantity:   Item Subtotal:  
$0.00
Total:
$0.00
 
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:
 Change Payment Method
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